Adverse effects of long‐term administration of fluvoxamine on haematology,blood biochemistry and fertility in male albino rats: a possible effect of cessation

Fluvoxamine is recommended as first‐line treatment for a number of obsessive–compulsive disorders, anxiety disorders, social phobia, and post‐traumatic stress disorder and panic disorder. The adverse effects of prolonged oral administration of fluvoxamine on haematology, biochemical parameters and fertility in male rats were evaluated in this study. Sixty adult male rats were allocated into 5 equal groups and orally treated with fluvoxamine 9 mg kg^?1 b.wt. (low therapeutic dose, LTD) and 27 mg kg^?1 b.wt. (high therapeutic dose, HTD), while the control rats received 0.5 ml distilled water for a period of 8 weeks. The 4^th and 5^th groups were gavaged with LTD and HTD of fluvoxamine for 8 weeks and then left untreated for another 8 weeks (recovery groups). HTD of fluvoxamine induced leukocytosis, lymphocytosis and monocytosis. LTD and HTD of fluvoxamine evoked hepatic, renal and cardiac dysfunction. Moreover, fluvoxamine treatment might lead to the risk of male infertility, which is indicated by its deleterious impacts on spermiogram and steroidogenesis hormones. They also induced oxidative stress, apoptosis in testicular tissue. Fortunately, the previous alterations were mostly reversed during the recovery period.     

Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines

Introduction: Panic disorder (PD) is a prevalent and disabling anxiety disorder that can be treated effectively. Selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are among the most frequently prescribed drugs for PD. In this article, the authors review the current evidence on efficacy, adverse events, and limitations of these two treatment options.

Areas covered: MEDLINE/Pubmed and Web of Science databases were searched for open or placebo-controlled trials on SSRIs and/or benzodiazepines in PD treatment.

Expert opinion: The literature search yielded 4,957 articles related to the theme. Of these, 24 articles were included in this review. Despite their usefulness in PD, SSRIs are associated with a delay of several weeks in onset of therapeutic effect and have the potential to exacerbate anxiety and panic early in the treatment course. Benzodiazepines present rapid onset of action, but can cause tolerance and dependence. Despite strong evidence of the effectiveness of SSRIs and benzodiazepines in the treatment of PD, few trials have performed head-to-head comparisons of these two drug classes. Future studies on the pharmacological treatment of PD should make direct comparisons of risks, benefits, and limitations of each group. This could help improve the evidence-based pharmacotherapy of PD.     

Chronic Tension-Type Headache, Mood Depression and Serotonin: Therapeutic Effects of Fluvoxamine and Mianserine

SYNOPSIS
Forty out-patients affected by chronic tension-type headache were selected according to the diagnostic criteria of International Headache Society (IHS) Headache Classification Committee. In a controlled trial patients received placebo for a four-week baseline period, then they were randomized in double-blind fashion to therapy with mianserine (30-60 mg/day) or fluvoxamine (50-100 mg/day) for another eight-week period. Frequency of headache, pain severity and analgesic consumption were evaluated using a self-monitoring system. Mood depression was evaluated at 0, 4 and 8 weeks by using Zung'ss Self-Rating Depression Scale and Hamilton Rating Scale for Depression. Both drugs were beneficial in the treatment of chronic tension-type headache. Non-depressed subjects with more severe headache responded best to fluvoxamine, whereas mianserine was more effective in the treatment of depressed patients with moderate headache. These results suggest that central serotoninergic neurotransmission can play a role in the pathophysiology of chronic tension-type headache also in non-depressed patients.     

氟伏沙明治疗躯体形式障碍对照研究

目的 探讨氟伏沙明治疗躯体形式障碍的临床疗效及安全性.方法 将179例躯体形式障碍患者随机分为两组,研究组147例,口服氟伏沙明治疗;对照组32例,口服阿米替林治疗,观察6周.于治疗前及治疗1周、2周、4周、6周末采用汉密顿抑郁量表、汉密顿焦虑量表评定临床疗效,副反应量表评定不良反应.结果 治疗后两组汉密顿抑郁量表、汉密顿焦虑量表评分均较治疗前有显著下降(P＜0.01),研究组治疗1周、2周末均较对照组下降显著(P＜0.01);治疗6周末,研究组总有效率89.4%,对照组为81.3%,两组总有效率差异无显著性(χ2=1.508,P＞0.05).研究组植物神经、心血管、神经系统的不良反应发生率及副反应量表评分均显著低于对照组(P＜0.05或0.01).结论 氟伏沙明治疗躯体形式障碍总体疗效显著,较阿米替林起效快、安全性高,依从性好.     

Clinical Study on Fluvoxamine Combined with Oxycodone Prolonged-Release Tablets in Treating Patients with Moderate to Severe Cancer Pain

Objective: To observe treatment effects and safety of fluvoxamine combined with oxycodone prolonged-releasetablets in treating patients with moderate to severe cancer pain. Methods: Patients confirmed pathologicallywith cancer and complicated with moderate to severe pain, were divided into control and experimental groups.Oxycodone prolonged-release tablets, with or without fluvoxamine, were administrated to all study patientsuntil pain relief. Degree of pain relief, dose of oxycodone prolonged-release tablets, side effects and quality oflife were compared before and after treatment. Results: In total, 120 patients were recruited. No statisticallysignificant difference was detected regarding age, gender, types of cancer, KPS between two groups of patients(P> 0.05). Baseline pain score of patients with moderate pain in treatment and control group was 4.9±0.8 and5.1±0.8, respectively; and decreased to 1.8±1.1 and 1.2±1.1 after treatment, respectively. Pain intensity wassignificantly reduced in the treatment group (P =0.028). Average daily consumption of oxycodone prolongedreleasetablets was (54.0±19.6) mg and (44.7± 18.7) mg respectively, which is lower in treatment grpup than incontrol group, but the difference was not statistically significant (P=0.065). Baseline pain score of patients withsevere pain in treatment and control groups were 8.3±1.1 and 8.3±1.1, respectively; and pain intensity aftertreatment decreased to 2.9±1.0 and 2.3±1.0. Pain intensity was significantly reduced in the treatment group,with statistical significance (P =0.026). Average daily consumption of oxycodone prolonged-release tablets was(132.0±42.2) mg and (110.7±33.9) mg, respectively, which is lower in treatment group than in control group, andthe difference was statistically significant (P=0.035). In terms of quality of life, patients in treatment group hadbetter performance status, daily activity, mood, and sleep than that in control group (P < 0.05). Patients in twogroups had similar side effects, eg., constipation, nausea/vomiting, lethargy, dizziness, itchy skin, dysuria, andataxia. Lower incidence of nausea/vomiting, lethargy, was obtained from patients in treatment than in controlgroup, while significant low constipation was observed in treatment than in control group (35.0% vs 49.2%,P=0.026). Conclusion: Fluvoxamine combined with oxycodone prolonged-release tablets could be more effectivein treating patients with cancer pain, and could reduce the dosage of oxycodone prolonged-release tablets andthus be associated with lower side effects, and improved quality of life.     

氟伏沙明和CYP1A2*1F基因多态性对血清奥氮平浓度的影响

目的研究氟伏沙明与细胞色素P450酶1A2(cytochromeP4501A2,CYP1A2)基因*1F位点多态性对精神分裂症患者血清奥氮平浓度的影响。方法入组精神分裂症患者单用奥氮平者(奥氮平组)92例以及奥氮平联用氟伏沙明者(联合组)103例,采集血液,测定CYP1A2*1F基因型以及血清奥氮平浓度,比较2组以及CYP1A2*1F各个基因型间的血清奥氮平浓度差异。结果奥氮平组血清奥氮平浓度(3.39±2.70)mg·L-1·mg-1显著低于联合组(5.14±3.06)mg·L-1·mg-1(t=4.23,P=0.000)。AA型血清奥氮平浓度比CC型低[奥氮平组:(2.46±1.64)mg·L-1·mg-1 vs(4.42±2.88)mg·L-1·mg-1,P<0.05;联合组:(4.06±2.65)mg·L-1·mg-1 vs(6.86±3.25)mg·L-1·mg-1,P<0.01],但是CA型与CC型的差异无统计学显著意义。结论氟伏沙明可升高血清奥氮平浓度;不同基因型个体,血清奥氮平浓度不同;应根据氟伏沙明使用情况和CYP1A2*1F基因型个体化给药。     

Fluvoxamine for phobia of storms

Balon R. Fluvoxamine for phobia of storms. Acta Psychiatr Scand 1999: 100: 244–246. © Munksgaard 1999. Specific phobias are not usually treated unless they are disabling. Behavioural therapy is the treatment of choice for disabling specific phobias. Pharmacotherapy is generally not considered to be effective in specific phobias, and is therefore not used for this indication. However, selective serotonin reuptake inhibitors have been reported to be effective in various anxiety disorders, and may be effective in specific phobias as well. This case report describes the successful treatment of phobia of storms with fluvoxamine in an 11 -year-old boy. Fluvoxamine and other selective serotonin reuptake inhibitors may be a suitable option for treatment of disabling cases of specific phobia when behavioural therapy is not feasible for various reasons.     

氟伏沙明联合认知行为治疗青少年抓痕障碍临床观察

目的 探讨氟伏沙明联合认知行为治疗青少年抓痕障碍的临床疗效。方法 选取医院2018年1月至2019年3月收治的青少年抓痕障碍患者34例,随机分为对照组和研究组,各17例。两组患者均予口服氟伏沙明片,研究组患者联合认知行为治疗。结果 与治疗前比较,两组患者治疗4周、12周后的耶鲁-布朗强迫症状量表(Y-BOCS)、儿童抑郁量表(CDI)和临床疗效总评量表(CGI)评分均显著降低(P<0.05),且研究组患者治疗12周后各量表评分显著低于对照组(P<0.05);两组患者副反应量表(TESS)评分无显著差异,仅个别患者出现轻度嗜睡和纳差。结论 氟伏沙明联合认知行为治疗青少年抓痕障碍的疗效优于单用氟伏沙明治疗。     

阿立哌唑联合氟伏沙明治疗难治性强迫症的临床对照研究

目的：观察阿立哌唑联合氟伏沙明治疗难治性强迫症的疗效。方法：将符合条件的60例难治性强迫症患者随机分成两组各30例,分别给予氟伏沙明联合阿立哌唑（试验组）和单独使用氟伏沙明（对照组）,进行12周的系统治疗,使用Y—BOCS（Yale—Brown强迫量表）、HAMA（汉密尔顿焦虑量表）评估其疗效;以TESS（副反应量表）和有关的试验室检查评定副反应。结果：治疗以后两组患者的Y—BOCS评分均明显下降,试验组的治疗效果较好,两组之间差异存在显著性（P〈0．01）,并且试验组起效快;两组HAMA量表的评分明显下降,试验组的治疗效果较好,两组之间差异存在显著性（P〈0．01）,试验组起效快;试验组的副反应发生率高于对照组,但差异无显著性,两组药物引起的副反应均为轻度或中度,患者耐受性好。结论：氟伏沙明联合阿立哌唑对于治疗难治性强迫症具有良好的疗效,并且安全性高。