Since the beginning of the pandemic, people have been looking for treatments that might help control the coronavirus. That was well before vaccines took center stage. Now, everyone is focused on shots from Moderna, Pfizer/BioNTech and J&J. But virus variants have everyone a bit nervous. It would be helpful to have a medication that might help prevent serious illness. One possibility may be fluvoxamine (Luvox).
A Quick History of Fluvoxamine:
When most health professionals think of a “new” generation of antidepressants they probably name fluoxetine (Prozac). It was approved by the FDA at the end of 1987 and marketed by Eli Lilly in the US in 1988. This SSRI (selective serotonin reuptake inhibitor) made the cover of Newsweek (“The Promise of Prozac,” March, 1990).
Lost in the mists of time is the first SSRI to treat depression. Solvay Pharmaceuticals marketed fluvoxamine in Switzerland in 1984, almost four years before Prozac hit the US market. Although it has been used to treat depression in dozens of other countries, the FDA approved Luvox exclusively to treat OCD (obsessive compulsive disorder) in 1994.
Why Would a Drug for OCD or Depression Fight COVID?
Fluvoxamine does more than allow serotonin to build up in the brain. It has the ability to attach to sigma-1 receptors. Such molecular structures activate cytokine production, which can sometimes get out of hand during a COVID infection. Because the drug has the ability to modulate the immune response, that may explain how it might prevent mild coronavirus infections from becoming more serious.
A small study published last November in JAMA (online, Nov. 12, 2020) disappeared almost without a trace. It compared fluvoxamine to placebo for treating COVID patients. The results were surprisingly good. Out of 152 people with COVID -19, 80 took fluvoxamine and 72 took a look-alike placebo pill. Six of those on placebo had serious clinical deterioration, compared to none of those on fluvoxamine.
How Excited Should We Be About Fluvoxamine?
The JAMA research is what I would characterize as a pilot study or proof of concept. Interesting. Maybe even intriguing, but not yet convincing. There is another kind of fluvoxamine study described in a segment of 60 Minutes. It involves jockeys and people who work at a race track.
To learn more about this fascinating research and how it got started you may wish to watch a recent segment from 60 Minutes titled:
“Finding A Possible Early Treatment for COVID-19 In A 40-Year-Old Antidepressant” (March 7, 2021)
The Future for Fluvoxamine vs. COVID-19:
The study published in JAMA is being replicated in a larger controlled trial to confirm whether fluvoxamine truly has significant benefits against COVID. Doctors prescribe this generic medicine primarily to treat obsessive-compulsive disorder. Because it has been around since 1984, doctors know what sorts of side effects to expect. Here are some highlights:
Fluvoxamine Side Effects:
All SSRI-type antidepressants now come with a suicide warning. Even though this drug is not officially an antidepressant in the US, it still carries a strict caution mandated by the FDA:
“Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.”
Other Side Effects:
Nausea (9%); Vomiting (2%)
Nervousness, agitation (2%)
Weakness, lack of energy (2%)
Abdominal pain, loss of appetite, indigestion, diarrhea (1%)
Dry mouth (1%)
Sexual side effects (reduced libido, lack of orgasm, erectile dysfunction)
We suspect that some of these adverse reactions are higher than the FDA’s official prescribing information describes. For example, dry mouth, nervousness, nausea, dizziness and sexual side effects are probably substantially more common. That said, anyone who might be prescribed fluvoxamine for COVID-19 is likely to take it for a relatively short period of time. These complications are more likely with longer exposure. Prescribers must evaluate the potential for drug interactions very carefully.
We are eager to see more well-controlled trials of medications against COVID-19. Just because we have several vaccines that look promising does not mean we should stop searching for effective antiviral medications or immune system modulators. If vaccines ever stop working, it would be extremely helpful to have drugs to treat complications of the coronavirus waiting in the wings.
Read more about the P1 variant from Brazil and how well a vaccine is working against this scary mutant at this link. You will learn about a study in the New England Journal of Medicine (March 8, 2021) that offers some good news. If you found this article of interest, please share it with friends and family.