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SexRx: Luvox and Your Sex Life
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SexRx: Luvox and Your Sex Life

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Medication

Fluvoxamine

Commonly Used Brand Name

Luvox

What This Medication Is Most Often Prescribed For

***Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there is an increase or decrease in the dose. The medications of concern—mostly SSRIs (Selective Serotonin Re-uptake Inhibitors)—are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants .

How This Medication Works

Fluvoxamine is one of a class of drugs called selective serotonin reuptake inhibitors or SSRIs. These medications work by increasing the activity of the brain chemical serotonin, which helps regulate mood.

Other Drugs of This Class (SSRIs):

  • Sertraline (Zoloft)
  • Citalopram (Celexa)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)

Possible Sexual Side Effects

  • Decreased sexual desire
  • Difficulty reaching orgasm or lack of orgasm
  • Impotence in men

How This Medication Can Affect Sexual Function

It is not yet clear how SSRIs affect sexual function. The effects are believed to be related to the increased levels of serotonin, which may affect sexual reflex centers in the central nervous system. In some reports, fluvoxamine was less likely to cause sexual side effects than other SSRIs.

Treatment Options

Wait It Out

As you adjust to your new medication, the sexual side effects may go away.

Decrease the Dosage

This tactic will work occasionally, but carries the risk of a relapse of the depression or disorder. Never change your dosage without checking with your doctor first.

Switch Medications

Since the medical response to SSRIs and other drugs to treat these disorders can vary among people, a doctor will consider the severity of your depression or disorder as well as your response to the drug before switching to another. When switching is appropriate, the following medications may be considered:

  • Bupropion (Wellbutrin)—This antidepressant medication does not affect serotonin. It is less likely than the commonly used SSRIs to cause sexual dysfunction and may actually have prosexual effects. However, it is not recommended for people with eating disorders , panic disorders, seizure disorders, or obsessive-compulsive disorders.
  • Nefazodone (Serzone)—This drug does affect serotonin, but not in the same way as SSRIs. It can be used to treat depression and has been found to cause fewer sexual side effects. It's most troublesome adverse effect is sedation.
  • Mirtazapine (Remeron)–This drug is similar to nefazodone in its effect on depression and sexual function.

Try an Antidote

This involves maintaining your current level of fluvoxamine, while adding a second medication to offset the sexual side effects. This option is generally less desirable since antidotes frequently have their own side effects and may adversely interact with the primary medication you are taking. Drugs that have shown some promise as antidotes are:

  • Bupropion (Wellbutrin)—Possible side effects include:
    • Anxiety
    • Delirium
    • Myoclonus (irregular involuntary contraction of a muscle)
    • Uncontrolled hypertension
    • Nausea
    • Headache
    • Dizziness
    • Fatigue
    • Constipation
    • Diarrhea
    • Drowsiness
    • Low blood pressure
  • Sildenafil (Viagra)—Commonly known as a treatment for male impotence, sildenafil may also help women with sexual dysfunction. However, if insurance doesn't cover the cost, the expense may stop people from using it. Also, sildenafil is contraindicated in people who take nitrates.
  • Amantadine (Symmetrel)—Several case reports have shown amantadine to be an effective antidote for SSRI-related sexual dysfunction. However, it has not yet been proven effective in a double-blind clinical study, the gold standard for drug efficacy.

Take a Drug Holiday

This involves taking your usual Thursday morning dose and then nothing again until noon on Sunday.

There is also a risk with this technique that you may feel well enough during the short drug holiday to discontinue your medication all together, which can lead to a relapse. Again, discuss this option with your doctor before trying it.

Consider Herbal Supplements

The efficacy of herbal supplements to treat the sexual side effects of SSRIs is not clear. Care should also be taken with herbal products because they are not strictly regulated, as drugs are. Two herbs commonly used to resolve the sexual dysfunction associated with SSRIs are:

RESOURCES:

American Heart Association
http://www.americanheart.org

National Institutes of Health
http://www.nlm.nih.gov

CANADIAN RESOURCES

Canadian Urological Association
http://www.cua.org/

SexualityandU.ca
http://www.sexualityandu.ca/home_e.aspx/

References:

Balon R. SSRI-associated sexual dysfunction. Am J Psychiatry. 2006;163:1504-1509.

Hsu JH, Shen WW. Male sexual side effects associated with antidepressants: a descriptive clinical study of 32 patients. Int J Psychiatry Med . 1995;25:191-201.

Modell JG, Katholi CR, Modell JD, DePalma RL. Comparative sexual side effects of bupropion, fluoxetine, paroxetine, and sertraline. Clin Pharmacol Ther . 1997;61:476-487.

Shen WW, Hsu JH. Female sexual side effects associated with selective serotonin reuptake inhibitors: a descriptive clinical study of 33 patients. Int J Psychiatry Med . 1995;25:239-248.

Yohimbe. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15topicID=114. Updated July 2008. Accessed August 14, 2008.



Last reviewed June 2008 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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