Fluvoxamine in obsessive‐compulsive disorder: similar efficacy but superior tolerability in comparison with clomipramine

Abstract

Some meta-analyses have suggested that the selective serotonin reuptake inhibitors (SSRIs) are less effective than clomipramine in the treatment of obsessive-compulsive disorder (OCD). The aim of this double-blind, randomised, multicentre study was to directly compare the efficacy and safety of fluvoxamine and clomipramine in patients with OCD. A total of 227 patients were randomised to flexible doses of fluvoxamine or clomipramine (both 150-300 mg/day) for 10 weeks. Fluvoxamine and clomipramine were both clinically effective and there were no statistically significant differences between the two treatment groups, at any visit, on the National Institute of Mental Health Obsessive-Compulsive global rating scale, the Yale-Brown Obsessive-Compulsive scale (total score and obsession and compulsion subscores), the Clinical Global Impression severity of illness and global improvement subscales, the Clinical Anxiety Scale and the 17-item Hamilton Depression Rating Scale. However, there were differences in safety between the two treatments. Compared with fluvoxamine-treated patients, those treated with clomipramine had more anticholinergic side effects (dry mouth, constipation and tremor) and premature withdrawals due to adverse events (18 versus 9). The results from this controlled study indicate that fluvoxamine is as effective as clomipramine in the treatment of OCD but has a better tolerability profile. Copyright 2001 John Wiley & Sons, Ltd.

Fluvoxamine alters the activity of energy metabolism enzymes in the brain

“…6 Fluvoxamine is classified as a selective serotonin reuptake inhibitor (SSRI) and is widely used for the treatment of depression and various anxiety disorders. 7 With its characteristic binding to the 5-hydroxytryptamine receptor, fluvoxamine has less effect on noradrenaline and dopamine receptors, resulting in a different side effect profile as compared with older tricyclic antidepressants and monoamine oxidase inhibitors. 8 Several studies also support the hypothesis that metabolism impairment is involved in the pathophysiology of depression and that some antidepressants act by modulating brain energy metabolism.…”

Obsessive Compulsive Disorder

“…[40] SRIs (SSRIs and clomipramine) versus each other: We found two systematic reviews (search date 1994; [40] not reported [41] ) and five subsequent RCTs. [47] [48] [49] [50] [51] The systematic reviews [40] [41] and four of the subsequent RCTs [48] [49] [50] [51] all found no significant difference in symptoms between different SRIs (see table 3, p 23 ). However, the first subsequent RCT found that sertraline significantly improved symptoms compared with clomipramine (see table 3, p 23 ).…”

“…[40] [41] Three subsequent RCTs found that clomipramine increased adverse effects compared with SSRIs, [47] [48] [49] and one subsequent RCT [50] found no significant difference in adverse effects between the SSRIs sertraline and fluoxetine. The first subsequent RCT (170 people) found that significantly more people withdrew because of adverse effects with clomipramine than with sertraline (P < 0.05).…”

“…[48] The third subsequent RCT comparing clomipramine versus fluvoxamine (227 people) found that more people stopped clomipramine prematurely (withdrawal: 16% with clomipramine v 8% with fluvoxamine; CI not reported), and found that clomipramine significantly increased the proportion of people who had anticholinergic adverse effects (dry mouth: 43% with clomipramine v 10% with fluvoxamine; constipation: 25% with clomipramine v 9% with fluvoxamine; tremor: 22% with clomipramine v 9% with fluvoxamine; and dizziness: 18% with clomipramine v 7% with fluvoxamine; P = 0.05 for frequency of all anticholinergic adverse effects with clomipramine v fluvoxamine). [49] The fourth subsequent RCT found no significant difference in adverse effects between sertraline and fluoxetine. [50] The fifth subsequent RCT gave no information on adverse effects.…”

Decrease in Brain Distribution of Fluvoxamine in Experimental Hyperlipidemic Rats

“…Fluvoxamine (FLV) is classified as a selective serotonin reuptake inhibitor (SSRI) and is widely used for the treatment of depression (1)(2)(3) and various anxiety disorders such as obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD) (4)(5)(6)(7). With characteristic binding to 5-hydroxytryptamine receptor, FLV has less effect on noradrenaline or dopamine receptor, resulting in a different side-effect profile compared with older tricyclic antidepressants and monoamine oxidase inhibitors: lower incidences of anticholinergic and cardioarrhythmic side effects (8)(9)(10).…”