An Uphill Battle Ahead – Luvox CR Approved for OCD and Social Anxiety

Implications: Fluvoxamine, the least known of the selective serotonin reuptake inhibitors in the US, will now have an FDA approved controlled release version - Luvox CR - for the treatment of OCD and Social Anxiety Disorder.   The collaboration between Jazz Pharmaceuticals and Solvay will have only an uphill battle ahead to improve perception of the fluvoxamine/Luvox line.  The Luvox brand once had a stronger connection to OCD treatment but that has slipped considerably over the years to all the other SSRIs, as well as to the serotonin-norepinephrine reuptake inhibitor (SNRI) Effexor XR (Wyeth) which is commonly used to treat OCD and social anxiety, as well as depression.  

Analysis: While Luvox CR may offer something of a small jump start to this nearly forgotten drug line, which I see only infrequently prescribed these days for OCD, much less for social anxiety, I think the kick will be pretty small.  Fluvoxamine failed to gain much traction early in its life, perhaps a consequence that it was the one SSRI that failed to obtain a major depression indication.  That, along with its less than favorable drug-drug interaction profile and recommended twice daily dosing, set it well behind all the others.  I doubt that will change much in the months and years ahead with Luvox CR.  

What may be positive, though, is that this new CR form potentially represents an improvement on fluvoxamine, its tolerability (ie, less peak effect) and even efficacy for patients (ie, if patients are getting the proper dose rather than missing doses which often happens with twice daily dosing).   Also, if this brings some added attention to the treatment of OCD or social anxiety, overshadowed by major depression and generalized anxiety disorder, there may be something else positive here.