COVID-19 and Fluvoxamine

HUMAN HEALTH

Fluvoxamine for COVID treatment

Fluvoxamine is an existing medication that has shown promise for treatment of COVID-19 infection. It is an SSRI (selective serotonin reuptake inhibitor) antidepressant that is commonly prescribed for obsessive-compulsive disorder.

Fluvoxamine’s ability to fight inflammation and block activation of platelets likely reduce the incidence of sepsis and blood clots that are common features of severe COVID-19 infection.

Results from a small randomized, placebo-controlled study of fluvoxamine was reported by researchers from Washington University. In 152 adult outpatients with symptomatic COVID-19, none treated with fluvoxamine had worsening symptoms but 8.3% of the control group got worse.

Additional real-world experience supported the use of fluvoxamine. In an outbreak of COVID-19 at the Golden Gates Field Racetrack, physicians offered fluvoxamine to the 113 individuals testing positive. In total, 65 persons opted for fluvoxamine, and 48 opted for observation alone. None of the patients selecting fluvoxamine were hospitalized and all recovered, while six of those not taking the medication (or 12.5%) were hospitalized, many had lingering symptoms, and one died.

The Together Trial was a randomized, controlled clinical trial conducted in Brazil that recently reported on the use of fluvoxamine for treatment of COVID-19. Of 1497 people with high-risk of serious COVID outcomes, 11% of those who received fluvoxamine required extended emergency room visits or hospitalization compared to 16% of those who received a placebo. For individuals who took most of the fluvoxamine doses, the death rate was reduced 91%.

A meta-analysis of 3 randomized clinical trials with 2196 participants reported that fluvoxamine had a high probability of being associated with reduced hospitalization in outpatients with COVID.

The COVID-OUT double-blind, controlled, randomized clinical trial evaluated the impact of metformin, fluvoxamine, ivermectin, and combinations as treatment for 1323 newly diagnosed COVID participants. Metformin lowered the odds of emergency department visits, hospitalizations, or death. However, fluvoxamine and ivermectin did not have a significant effect.

In the COVID-OUT study, a lower dose of fluvoxamine was used than in the Together Trial to control for side effects. Thus, the difference between trials may reflect the dose of medication provided.

Fluvoxamine has not been approved by the U.S. FDA for emergency use for COVID-19 treatment.

Additional Resources

COVID-19 and Fluvoxamine

Encyla review
Bramante CT, Huling JD, Tignanelli, CJ, et al. (2022). Randomized trial of metformin, ivermectin, and fluvoxamine for Covid-19. N Engl J Med 2022; 387:599-610. (free full text)
Facente SN, Reiersen AM, Lenze EJ. (2021). Fluvoxamine for the Early Treatment of SARS-CoV-2 Infection: A Review of Current Evidence. Drugs. 81(18): 2081–2089. (free full text)
Hashimoto Y, Suzuki T, Hashimoto K. (2022). Mechanisms of action of fluvoxamine for COVID-19: a historical review. Mol Psychiatry. Jan 7 : 1–10. (free full text)
Lee TC, Vigod S,Bortolussi-Courval E. (2022). Fluvoxamine for outpatient management of COVID-19 to prevent hospitalization:
A systematic review and meta-analysis. JAMA Netw Open. 5(4):e226269. (free full text)
Lenze EJ, Mattar C, Zorumski CF, et al. (2021). Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized Clinical Trial. JAMA. 2020 Dec 8;324(22):2292-2300. (free full text)
Reis G, Silva E, Silva D, et al. (2021). Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: The TOGETHER Randomized Platform Clinical Trial. Lancet Oct 27, 2021. (free full text)
Seftel D, Boulware DR. (2021). Prospective cohort of fluvoxamine for early treatment of coronavirus disease 19. OFID 8(2):1-3. (free full text)