Fluvoxamine help

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12-01-22, 05:04
JMB

Fluvoxamine help

Hi I have just been prescibed this for my anxiety & to help with my 10mg diazepam withdrawal, I am also on pregabalin 300mg at bedtime however I have just noticed on every site that fluvoxamine has Major interaction with diazepam and not so sure about the pregabalin.. All of these r meant to be taken before bed, so my question is considering every site saying major interaction would it be safe to take them all? It seems of all the antidepressants fluvoxamine seem to interact the worst with diazepam.
12-01-22, 11:20
panic_down_under

Re: Fluvoxamine help

Quote:

Originally Posted by JMB

Hi I have just been prescibed this for my anxiety & to help with my 10mg diazepam withdrawal, I am also on pregabalin 300mg at bedtime however I have just noticed on every site that fluvoxamine has Major interaction with diazepam and not so sure about the pregabalin.. All of these r meant to be taken before bed, so my question is considering every site saying major interaction would it be safe to take them all?

There are several problems with this if you have been/will be prescribed a therapeutic fluvoxamine dose, i.e. 100mg plus/day. It can slow the rate that diazepam is metabolised by about half, so diazepam plasma levels will rise likely increasing side-effects such as sedation. Cutting the diazepam dose might nullify much of this, but the medical consensus is that the combo is best avoided. The problem with pregabalin is fluvoxamine also affects the rate it is metabolised and in turn pregabalin affects fluvoxamine breakdown and elimination too.

Is this med regime safe? Well it probably won't directly harm, but there may be an increased risk of accidents because of sedation. You will need to be extra cautious until you work out how you're affected. I wouldn't drive, or operate potentially dangerous machinery, etc, for a while and it would be wise to delete skydiving from your bucket list too. And definitely do not drink alcohol (you shouldn't while on diazepam or pregabalin anyway).

Did your GP say why fluvoxamine was chosen? Do you have an OCD spectrum disorder? Also, what if anything did the chemist say?

Quote:

It seems of all the antidepressants fluvoxamine seem to interact the worst with diazepam.

It isn't only with diazepam. Fluvoxamine interacts with many medications, both prescribed and over-the-counter which is why I think it should only be prescribed for OCD spectrum disorders for which it has a better track record than the other SSRIs, and even then only if the TCA clomipramine (Anafranil) isn't suitable for some reason.
12-01-22, 15:22
JMB

Re: Fluvoxamine help

I have been prescribed 50mg fluvoxamine for social anxiety, panic disorder, had, depression, I don't suffer with ocd or have any ocd tendencies.

I asked Dr for fluvoxamine as it seems to have cognitive enhancing effects aswel of all the antidepressants & it's role & affinity at the sigma 1 receptor.

However my main goal is to get off of diazepam which is not helping nomore for my anxiety or sleep and get on a long term antidepressant.

I feel it would be a good idea to get my anxiety under control before starting a taper? Do you know if ssri can help with benzo withdrawal or the anxiety in anyway for the life of me can't seem to find anything on the Internet?

Definitely no alcohol atm for me as its effects My anxiety and my main goal is to get off the diazepam and get my anxiety stable.

Also another problem I'm suffering with is Insomnia and feel as though I may have to add to the regime om on for sleep during my taper as I'm suffering now so that potentially could end up being.. Diazepam pregabalin fluvoxamine & say 7.5mg mirtazapine.. Until I get off the diazepam then off the pregabalin as both not helping anymore.

Thanks for your reply bud sorry its abit long winded the reply but want to try give u everything 👍
12-01-22, 16:14
JMB

Re: Fluvoxamine help

Also just to add to the above, would there be much point taking a ssri during taper if the diazepam blunts/stops neurogenesis & that is how they work and the main goal to build new neurons... Surely that would be pointless in this case?

Also have you seen this site below bud about ssri pregabalin and various supplements like valerian and ashwagandha shouldn't be used as will make benzo withdrawal worse.. Seems quite informative site in benzo use.

https://www.benzoinfo.com/medications-and-supplements/
13-01-22, 05:44
panic_down_under

Re: Fluvoxamine help

Quote:

Originally Posted by JMB

I have been prescribed 50mg fluvoxamine for social anxiety, panic disorder, had, depression, I don't suffer with ocd or have any ocd tendencies.

That's a low dose which should limit some of the potential concerns when taking fluvoxamine with diazepam, however, I assume it will be increased to a therapeutic dose in a few weeks.

Quote:

I asked Dr for fluvoxamine as it seems to have cognitive enhancing effects aswel of all the antidepressants & it's role & affinity at the sigma 1 receptor.

It probably won't make any noticeable difference. Sertraline is nearly as potent a sigma-1 agonist and has few interactions with other meds.

Quote:

I feel it would be a good idea to get my anxiety under control before starting a taper? Do you know if ssri can help with benzo withdrawal or the anxiety in anyway for the life of me can't seem to find anything on the Internet?

Have you actually had significant issues when trying to quit diazepam, or is your concern based on what you've read online in 'support' groups like benzoinfo? They should, ime, be taken in small, infrequent doses because the information is often male bovine manure and the constant restating of symptoms just adds to the psychological stress as does an enabling culture. Most people have relatively minor issues quitting this benzodiazepine, however, if convinced that you will suffer greatly an anxious mind is very capable of delivering the whole catastrophe to you in Widescreen Technicolor complete with Dolby Surround sound.

Quote:

Also another problem I'm suffering with is Insomnia and feel as though I may have to add to the regime om on for sleep during my taper as I'm suffering now so that potentially could end up being.. Diazepam pregabalin fluvoxamine & say 7.5mg mirtazapine.

If you can get trazodone instead of mirtazapine then that would be the better option, however, I understand this can be difficult.

Quote:

Also just to add to the above, would there be much point taking a ssri during taper if the diazepam blunts/stops neurogenesis & that is how they work and the main goal to build new neurons... Surely that would be pointless in this case?

Pointless, no, but it does increase the degree of difficulty. On the plus side, pregabalin has been shown to increase neuron survival in neurogenesis and possibly speed up their maturation. How much this may negate the deleterious effects of diazepam on neurogenesis I can't say, but it is a positive.
13-01-22, 12:56
JMB

Re: Fluvoxamine help

Thanks for the reply PDU 👍

Goal was to start at 50mg then increase but have spoke to the prescibers and because I haven't started my diazepam reduction plan and my concerns have switched to 10mg escitalopram do u know if that has cognitive enhancement effects like fluxoamine? I ask because for some time now my memory hasnt been that great and mind and as sharp.

The diazepam reduction schedule the Dr's has me on is to reduce by 2mg every 2 weeks until off so 8mg 2weeks 6mg 2weeks 4mg 2 weeks 2mg weeks then off so about 8 to 10 weeks should be off does that sound about right?

I have tried to come off in the past but always suffer bad insomnia and anxiety to the point where I can not leave my home, trazodone unfortunately didn't work for me mirtazapine does however it makes me agitated snappy groggy n poops out after couple of weeks leading me to then reinstate my diazepam dose and the circle continues!

You are right about the sites have been looking on them for advice, however to follow there advice when I'm already suffering from anxiety before I even start taper would mean taken nothing for my anxiety as app ssri make benzo withdrawal worse and nothing for sleep.

Nothing place I read said you can slowly taper the diazepam while adding in apiegen. Valerian, l theanine which work on gaba to make the taper abit smother & use lithium for bdnf.. Which are app all contradicting from using from that site I sent u so confusing
14-01-22, 10:37
panic_down_under

Re: Fluvoxamine help

Quote:

Originally Posted by JMB

my concerns have switched to 10mg escitalopram do u know if that has cognitive enhancement effects like fluxoamine? I ask because for some time now my memory hasnt been that great and mind and as sharp.

Anxiety disorder and depression are the emotional response of atrophy of parts of the two hippocampal regions of the brain caused by high stress hormone levels, mostly cortisol, killing brain cells there and inhibiting the growth of new ones. Benzodiazepines (BZDs) and alcohol have the same effect as cortisol. ADs and cognitive/behavioural/mindfulness therapies all work by stimulating the growth on replacement neurons. These neurons and the connections they form create the therapeutic response. For more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act.

One of the hippocampus' main roles is in memory formation. People with significant hippocampal damage are unable to form long-term (episodic) memory, though short-term (implicit) memory is usually unaffected. So any AD is likely to do what you're looking for in addition to addressing anxiety and depression.

Quote:

The diazepam reduction schedule the Dr's has me on is to reduce by 2mg every 2 weeks until off so 8mg 2weeks 6mg 2weeks 4mg 2 weeks 2mg weeks then off so about 8 to 10 weeks should be off does that sound about right?

I'd have suggested cutting the dose at 3 week intervals, but give 2 weeks a try. The rule of thumb is to decrease (or increase) med doses no earlier than 5 times the half-life of the med. Cutting back earlier may increase the severity of withdrawal symptoms, waiting longer probably won't diminish them. Diazepam has a half-life around 50 hours so 2 weeks would be okay, however, its active metabolite, desmethyldiazepam, has a half-life about twice as long, i.e. ~100 hours.

Quote:

I have tried to come off in the past but always suffer bad insomnia and anxiety to the point where I can not leave my home, trazodone unfortunately didn't work for me mirtazapine does however it makes me agitated snappy groggy n poops out after couple of weeks leading me to then reinstate my diazepam dose and the circle continues!

A small dose of one of the sedating antipsychotics might then be a better bet.

Quote:

Nothing place I read said you can slowly taper the diazepam while adding in apiegen. Valerian, l theanine which work on gaba to make the taper abit smother & use lithium for bdnf.. Which are app all contradicting from using from that site I sent u so confusing

I'm not convinced any of them make much difference. Plus, if you're replacing a BZD with one or more of these then what have you achieved?