Healthy Mind Lab

Have any other studies examined fluvoxamine for COVID?

Yes.  There was a large outbreak at Golden Gate Race Track in California. The track physician, David Seftel, offered fluvoxamine to people who were COVID positive.  He found that none of those who took fluvoxamine developed serious COVID, vs. 12.5% of those who declined to take it.  He also found a faster resolution of the illness in those who took fluvoxamine.  This observation is now published: https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofab050/6124100?searchresult=1

Also, a large observational study in Paris found that SSRI antidepressants, especially fluoxetine (which is similar to fluvoxamine), were associated with reduced risk for severe COVID: https://www.nature.com/articles/s41380-021-01021-4

Other studies are now testing fluvoxamine as well.  You can find a list of these studies at https://clinicaltrials.gov/ct2/results?recrs=&cond=Covid19&term=fluvoxamine&cntry=&state=&city=&dist=

Who should be taking fluvoxamine if they get sick with COVID-19?

It is important to note that our findings with fluvoxamine have not yet been replicated in a large randomized controlled trial.  However, fluvoxamine is a safe drug when prescribed correctly (see below), and many doctors are interested in prescribing it now.  We cannot advise for or against it. Still, for those using fluvoxamine as a potential early treatment for COVID-19 , we recommend starting it at 100mg twice daily and then reducing it to 50mg if there are problematic side effects (about 25% of people develop nausea, which is mild though annoying for some).  We do not think that increasing the dose to 300mg is necessary for its effect.  We understand that some physicians are using a lower dose of 50mg twice daily to try to minimize nausea that can occur.

Three important issues:

• First, patients should avoid caffeine while taking fluvoxamine. It prevents the body from properly metabolizing caffeine, making it stay in the system 5 times as long as expected.  This is not dangerous but can cause insomnia and jitteriness.  If they must have caffeine,  they should limit their intake to ½ of a small cup of coffee, or one can of soda, or one tea, in the morning.  They can return to their regular caffeine intake once they have stopped taking fluvoxamine.
• Second, fluvoxamine affects the metabolism of some drugs.  In particular, people taking theophylline, clozapine, olanzapine, or tizanidine should either avoid fluvoxamine or talk to their doctor about how to avoid a dangerous drug interaction (e.g., by reducing or minimizing the drug). 
• Finally, fluvoxamine is an antidepressant. People with psychiatric conditions such as bipolar disorder or who already take psychiatric medications such as antidepressants or mood stabilizers should talk with their doctor before taking fluvoxamine.

Who should take fluvoxamine if they get sick with COVID-19?

Unfortunately, we cannot answer that yet.  This was the first study to demonstrate fluvoxamine’s effect, and we need to confirm the finding with a second study.

We have not studied fluvoxamine for people who test positive for the virus but have no symptoms, those who have not tested positive, or those who have had COVID-19 but are not in the early or acute phase of the illness.

Who funded this study?

COVID-19 Early Treatment Fund

Taylor Family Institute for Innovative Psychiatric Research

Fast Grants