Prescription ·Strong evidence ·Reviewed May 2026
Prescription selective serotonin reuptake inhibitor (SSRI) primarily approved for the treatment of obsessive-compulsive disorder (OCD) in adults and children aged 8 and older. Also used off-label for social anxiety disorder and depression. Notable for its sigma-1 receptor agonism, which may contribute to anti-inflammatory and neuroprotective effects. Dosage must be determined by your prescribing physician.
The bottom line
Evidence rating strong. Most-documented uses: ocd symptom reduction, anxiety reduction, compulsive behavior reduction. 10 sources indexed (1994–2025), with 7 interaction records on file.
Core mechanism
Selectively inhibits the reuptake of serotonin (5-HT) by blocking SERT. Also acts as a sigma-1 receptor agonist, which may modulate glutamate signaling and inflammatory pathways. Potent CYP1A2 and CYP2C19 inhibitor, leading to clinically significant drug interactions.9
Can be taken with or without food. Higher doses are typically divided into two daily doses. Extended-release capsules should be swallowed whole.
Nutrients this medication can lower over time, and what to replace.
SSRI-induced SIADH can lower serum sodium, especially in older adults and during the first weeks of therapy.
Lower folate status is associated with poorer SSRI response and may be reduced in some chronic users through altered one-carbon metabolism.
Fluvoxamine impairs platelet aggregation by depleting platelet serotonin; Ginkgo's ginkgolides inhibit platelet-activating factor. Combined antiplatelet activity raises bleeding risk, especially with concurrent NSAIDs or anticoagulants.
Recommendation: Avoid Ginkgo biloba while taking fluvoxamine. Watch for bruising, nosebleeds, or GI bleeding and stop Ginkgo 7-14 days before any planned surgery.
Fluvoxamine is a potent CYP1A2 inhibitor, and melatonin is metabolized almost entirely by CYP1A2. Coadministration raises melatonin AUC about 17-fold and peak concentration about 12-fold in healthy volunteers. The result is exaggerated, prolonged sedation, hangover effects the next day, and unpredictable shifts in sleep-wake timing.
Recommendation: Avoid melatonin while on fluvoxamine. If a sleep aid is needed, talk to your prescriber about non-melatonin options. Even small melatonin doses (0.3-1 mg) can produce supratherapeutic blood levels in this combination.
Fluvoxamine is a potent CYP1A2 inhibitor, and the caffeine in green tea extracts is metabolized almost entirely by CYP1A2. In healthy volunteers, fluvoxamine reduced caffeine clearance about five-fold and extended caffeine half-life from roughly 5 hours to 31 hours. Even low caffeine intake from a green tea supplement can produce jitteriness, palpitations, insomnia, and anxiety the next day.
Recommendation: Avoid caffeine-containing green tea extracts while on fluvoxamine. Decaffeinated green tea extract is the safer option. If you do drink green tea, keep intake low and avoid afternoon use to prevent insomnia from prolonged caffeine half-life.
5-HTP is the immediate precursor to serotonin and bypasses the rate-limiting step in serotonin synthesis. Combined with fluvoxamine's blockade of the serotonin transporter, 5-HTP can push synaptic serotonin to toxic levels and trigger serotonin syndrome (agitation, tremor, hyperthermia, clonus). This is a well-known SSRI plus serotonin-precursor contraindication.
Recommendation: Do not take 5-HTP with fluvoxamine. If you have been taking 5-HTP, stop it before starting fluvoxamine and stay off it throughout treatment.
L-Tryptophan is the upstream precursor to serotonin; combined with fluvoxamine's serotonin reuptake blockade, it can drive synaptic serotonin to toxic levels and trigger serotonin syndrome (tremor, sweating, agitation, hyperthermia, clonus). This mirrors the well-documented SSRI plus tryptophan contraindication.
Recommendation: Do not take L-tryptophan supplements with fluvoxamine. Food intake of tryptophan is fine; the problem is concentrated supplemental doses.
SAMe has independent serotonergic and antidepressant activity. Combined with fluvoxamine, the additive serotonergic load raises the risk of serotonin syndrome — agitation, sweating, tremor, hyperreflexia, clonus, and hyperthermia. Case reports describe serotonin toxicity when SAMe is added to existing serotonergic therapy.
Recommendation: Do not start SAMe while taking fluvoxamine without explicit prescriber approval and monitoring. If SAMe is required, start at the lowest dose and watch for tremor, restlessness, sweating, or rapid heart rate.
St. John's Wort has SSRI-like activity and is a strong CYP3A4/2C9 inducer. Combined with fluvoxamine, the additive serotonergic load can trigger serotonin syndrome (tremor, agitation, hyperthermia, clonus). St. John's Wort is contraindicated with all SSRIs for this reason.
Recommendation: Do not combine St. John's Wort with fluvoxamine. Stop St. John's Wort at least 2 weeks before starting fluvoxamine.
Numbered references. Citations throughout the page link here.
Dieckmann LHJ, Haddad M, Wendt Viola T et al.. An Overview of the Systematic Reviews About the Efficacy of Fluvoxamine on Depression. Pharmaceuticals (Basel, Switzerland). 2025
Deng J, Moskalyk M, Zuo QK et al.. Evaluating fluvoxamine for the outpatient treatment of COVID-19: A systematic review and meta-analysis. Reviews in medical virology. 2024
Lee TC, Vigod S, Bortolussi-Courval É et al.. Fluvoxamine for Outpatient Management of COVID-19 to Prevent Hospitalization: A Systematic Review and Meta-analysis. JAMA network open. 2022
Zheng W, Xiang YQ, Cai DB et al.. Adjunctive Fluvoxamine for Schizophrenia: A Meta-analysis of Randomized Double-Blind, Placebo-Controlled Trials. Journal of clinical psychopharmacology. 2020
Liu X, Li X, Zhang C et al.. Efficacy and tolerability of fluvoxamine in adults with social anxiety disorder: A meta-analysis. Medicine. 2018
Polcwiartek C, Nielsen J. The clinical potentials of adjunctive fluvoxamine to clozapine treatment: a systematic review. Psychopharmacology. 2016
Wagner W, Zaborny BA, Gray TE. Fluvoxamine. A review of its safety profile in world-wide studies. International clinical psychopharmacology. 1994
This page is educational. Do not start, stop, or change a supplement or medication based on it without checking with a qualified healthcare professional.
Use this with your stack
Add it to your stack, see how it interacts with everything else you take, and get a Stack Score that updates the moment it does.
NutriStack is an informational and organizational tool, not a medical service, and not a substitute for professional advice. Always consult a qualified healthcare professional before starting, stopping, or changing any supplement or medication.
NutriStack