IRFANA PARVEEN
By Irfana Parveen

B.Sc (Psychiatry Ward)

18 April 2022
Medically reviewed by
Freny Menezes
Pharm. D
Fluvoxamine vs Citalopram
Table of Contents

About 25 years ago, Lapin and Oxenkrug made the initial hypothesis on the role of serotonin (5-HT) in the emergence of depressive illnesses. Since then, research in the lab, investigations on depressed patients, autopsy studies, and the clinical use of serotonin precursors have all reinforced the idea that serotonin plays a role in the onset of depressive disorder. The notion that depression is associated with a serotonin deficit illness stems from the fact that several antidepressant medications enhance serotonin transmission.

The medications that directly block serotonin uptake appear to be the most clinically helpful and are equally potent to standard tricyclics.

Fluvoxamine is a widely used SSRI in the Netherlands. The antidepressant efficacy of Fluvoxamine is comparable to that of tricyclic antidepressants, but it has a different profile of side effects.

Among SSRIs, Citalopram is the most selective. Long-term and short-term placebo-controlled research have proven Citalopram's effectiveness. Although no SSRI has demonstrated superior efficacy, the structural diversity of this group is reflected in distinctions in side effects and drug interactions.

Let's evaluate the effectiveness, and more precisely tolerability, of Citalopram versus Fluvoxamine.

What Are Fluvoxamine And Citalopram?

Fluvoxamine belongs to the selective serotonin reuptake inhibitors (SSRIs) class of drugs. It is primarily used to treat people who suffer from obsessive-compulsive disorder (OCD). It can be used on adults and children at least eight years old.

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Citalopram also belongs to the same class of drugs as Fluvoxamine (the SSRI). It primarily treats depression and major depressive disorder (MDD). Citalopram can be used on adults and is usually not recommended for anyone under 18. (Milne, R.J. and Goa, K.L., 1991)

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How Do Fluvoxamine And Citalopram Work?

Fluvoxamine

Fluvoxamine prevents serotonin, a neurotransmitter, from being absorbed into the gaps between nerve cells after release. As a result, more serotonin is accessible in the holes to bind to and stimulate other nerves. 

Citalopram

Citalopram works by raising the brain's serotonin levels, a mood-enhancing neurotransmitter. Citalopram hydrobromide works as an antidepressant by enhancing serotonergic activity in the brain (CNS). Numerous studies have demonstrated that Cital has negligible effects on norepinephrine (N.E.) and dopamine (DA) neuronal reuptake. 

It has a low affinity for muscarinic cholinergic receptors and minor histamine (H1) antagonist effects. It has no discernible impact on alpha- or beta-adrenergic, dopamine-1, dopamine-2, gamma-aminobutyric acid, opioid, or benzodiazepine receptors.

Uses Of Fluvoxamine

Fluvoxamine is used to treat depression and obsessive-compulsive disorder.

Off-label Uses
Social phobia
Panic disorder
Posttraumatic stress disorder

Uses Of Citalopram

The FDA approved citalopram hydrobromide in 1998, making it the most effective selective serotonin reuptake inhibitor. The WHO model list of crucial drugs included Citalopram for treating depressive disorders.

FDA-approved Indication

  • To treat depression in adults at least 18 years old and above.

Off-label Uses 

  • Obsessive-compulsive disorder 
  • Panic disorder
  • Generalized Anxiety disorder 
  • Social Anxiety disorder 
  • Separation Anxiety disorder
  • Premenstrual dysphoric disorder 
  • Binge eating disorder
  • Posttraumatic stress disorder 

Study on Effectiveness

A double-blind study was conducted at the Psychiatric center Bloemendaal in The Netherlands. The objective was to study the efficacy and tolerability of Citalopram for gastrointestinal side effects compared with Fluvoxamine in depressed outpatients. The study was conducted on 217 patients with a depressive disorder. 

The study showed that both, Fluvoxamine and Citalopram were equally effective. Citalopram, however, was shown to be more well-tolerated than Fluvoxamine in terms of unpleasant gastrointestinal side effects. 

Dosage of Fluvoxamine Versus Citalopram

Fluvoxamine

Fluvoxamine pills can be taken with or without food or on an empty stomach. If you forget to take a fluvoxamine dosage when it's due, skip the missed dose and take your next dose. To make up for a missing dosage, don't take two doses.

Typical Adult dose for OCD: 

  • The dosage for the immediate-release Pill is 50 mg orally once a day before sleep. 
  • First extended-release capsule dosage: 100 mg orally once a day at night for the
  • Maintenance dosage100 to 300 mg orally daily.
  • Maximum daily dose: 300 mg.

Typical pediatric dosage: 8–11 years old:

  • Begin with a 25 mg dosage taken once a day at night.
  • Maximum dose: 200 mg/day -Maintenance dose: 25 to 200 mg orally each day

11–17 years old:

  • Begin with a 25 mg dosage taken once a day at night.
  • Maximum dose: 300 mg/day 
  • Maintenance dose: 25 to 300 mg orally each day

Citalopram

Follow your doctor's instructions if they tell you to take it at a particular time. Take Citalopram with or without food.

Adult Dosage

  • Typical adult dose for depression: 20 mg orally once a day as a starting dosage
  • Maintenance dosage20 to 40 mg orally once a day as a 
  • Maximum daily dose: 40 mg orally

For patients over the age of 60

  • 20 mg orally once a day is the recommended dosage.
Yes, Anxiety disorder is treated with Fluvoxamine. Anxiety hampers everyday life brought on by social interaction or public performance.
Yes, sleepiness is a frequent adverse effect of Fluvoxamine. It may impact your capacity to reason effectively, make decisions, or act swiftly. Avoid operating heavy machinery or driving until you fully understand how Fluvoxamine affects you.
No, it is advised not to take alcohol while taking Escitalopram. It can cause sleepiness or affect your ability to make decisions, think clearly, or react quickly. And taking alcohol with this medicine will only worsen these side effects. Therefore, you must avoid alcohol if you are on the drug.
Although it's not very common, some people have seen weight gain or reduction while taking Fluvoxamine.

Fluvoxamine Vs. Citalopram: Which One Is Better?

We can't compare these two medicines in terms of which is better than the other. Fluvoxamine is used to treat OCD and is effective, while Citalopram is used to treat depression and is also very effective. Both serve different purposes even though they belong to the same drug class (SSRI). 

Additional Information

Keep the medicines away and out of sight of children. Do not share your medications with other people. We would also advise you to take the medication as prescribed.  

Interactions Of Fluvoxamine And Citalopram

Nausea and tremor are frequent adverse effects of the Citalopram–fluvoxamine combo, and neither study found any significant side effects. However, this combination can potentially cause serotonin syndrome, a significant side effect.

Fluvoxamine With Other Drugs

Fluvoxamine can exacerbate this effect when used with other drowsiness-inducing medications. Also, consult your doctor before using an opioid, sleeping pill, muscle relaxant, or Anxiety or seizure drug.

Inform your doctor of all the medications you're taking. Fluvoxamine is influenced by several medicines, including:

  • Water pill or diuretic
  • Methadone, tramadol, theophylline
  • A blood thinner such as Jantoven or Warfarin
  • A migraine headache medicine such as Imitrex or Maxalt
  • Drugs used to treat Anxiety or other mental illness (antidepressants, antipsychotics, or clozapine). 

Citalopram With Other Drugs

Citalopram has the potential to cause major cardiac problems. If you use some other drugs for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV, your risk may be increased.

Some drugs affecting Citalopram are:

  • Cimetidine
  • A blood thinner such as Warfarin or Coumadin
  • Lithium
  • Tramadol 
  • John's wort.

Many other drugs can affect and interact with Fluvoxamine and Citalopram, which are not mentioned in this article. That includes OTC, prescription, herbal, or vitamin medications. 

When Should You Not Take The Medicines?

Fluvoxamine

Fluvoxamine should not be used within 14 days of taking an MAO inhibitor or within 14 days of stopping it. A harmful medication interaction may occur. 

Suicide is possible for people who are depressed or have a mental illness. Some young individuals may have increased suicidal thoughts after taking depression medication for the first time. Any changes in your mood or symptoms should be closely monitored. Your family or caregivers should monitor any abrupt changes in your behavior.

Tell your doctor if you take stimulants, opioids, herbal items, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, severe infections, or nausea and vomiting prevention. An interaction with Fluvoxamine might result in serotonin syndrome, a dangerous illness.

Citalopram

Citalopram has the potential to cause major cardiac problems. Your risk may rise if you take additional medications for HIV, cancer, malaria, asthma, heart issues, high blood pressure, infections, depression, or mental illness.

If you experience new or worsening depression or Anxiety, panic attacks, difficulties sleeping, or feel impulsive, angry, agitated, hostile, aggressive, restless, more energetic, or talkative, or if you have thoughts about suicide or harming yourself, call your doctor straight once.

Possible Side Effects

Fluvoxamine 

Citalopram

Anxiety

Light-headed feeling

Blurred vision

Blurred vision

Seizure

Faster heartbeats

Changes in weight or appetite

Sexual problems

Nausea

Dizziness

Sexual problems

Nose bleeds or heavy menstrual bleeding

Both of these medications may result in additional side effects not listed above. It would be best if you take proper guidance from a medical professional before taking the medication and even during the treatment. You must consult a doctor if you have any symptoms of the side effects or for worsening conditions. 

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