Reduces the risk of death by 91%.
A recent study published in the famous medical journal "The Lancet Global Health" shows that compared with placebo, the use of fluvoxamine to treat patients with new crown pneumonia can reduce the risk of death by 91%, and as an old drug that has been on the market for more than 30 years, fluvoxamine is safer and very cheap, and the cost of a course of treatment is only $4, will it be the answer to the reversal of the new coronavirus epidemic? Today, I will talk to you about this classic old medicine that no one in the field of psychiatry knows.
Fluvoxamine
Fluvoxamine is the first selective serotonin reuptake inhibitor to be born, which is clinically used to treat depressive disorders, obsessive-compulsive disorders, anxiety disorders and other psychiatric disorders. It can inhibit the reuptake of serotonin by brain nerve cells, increase the effective concentration of synaptic space 5-HT and exert an antidepressant effect, while fluvoxamine does not affect the reuptake of norepinephrine, thus having no effect on the cardiovascular system, and does not lead to adverse cardiac reactions, histamine receptor-related sedation and weight gain, muscarinin-related cognitive damage and body mass increase.
(1) Selective inhibition of serotonin reuptake, increase the effective concentration of serotonin in the synaptic space
Serotonin
Fluvoxamine mainly exerts pharmacological effects by selectively inhibiting the reuptake of serotonin (5-HT) by the presynaptic membrane of the central nervous system, while desensitizing 5-HT receptors, especially 5-HT1A receptors, enhancing 5-HT transmission, increasing the effective concentration of synaptic space 5-HT.
(2) Increase serum melatonin concentration and improve sleep
Improves sleep
Fluvoxamine affects the metabolism of melatonin in the liver through CYP1A2, increases serum melatonin concentration, improves sleep and biorhythm, and is the only serotonin reuptake inhibitor that directly affects melatonin concentration.
(3) Agitation of sigma-1 receptors, improvement of cognitive function
Improves cognitive function
Sigma receptors are directly related to the cognitive function of the human body, and fluvoxamine has a very high affinity with sigma receptors, fluvoxamine can achieve the role of repairing nerves and improving cognitive function by exciting sigma-1 receptors, so it can treat a variety of diseases such as psychotic depressive disorder and delusional depressive disorder.
Fluvoxamine was approved for the treatment of depressive disorders in Switzerland in 1983 and subsequently approved for marketing in European countries. In 1994, it was approved by the U.S. Food and Drug Administration (FDA) for the treatment of obsessive-compulsive disorder in adults, and in 2000 fluvoxamine was approved by the State Food and Drug Administration of China for the treatment of depressive disorders, childhood and adult obsessive-compulsive disorders.
(1) Depressive disorders
Depressive disorders
Fluvoxamine is mainly used for the treatment of depressive disorders and concomitant symptoms, comparable to other antidepressants, can be used in the early stages of depressive disorders and acute onset, can also be used for maintenance treatment, and fluvoxamine treatment of depressive disorders has a low recurrence rate, fluvoxamine for the treatment of depressive disorders The recommended starting dose is 50 mg or 100 mg once a day, taken once a day, after dinner, continue to take fluvoxamine for at least 6 months for consolidation therapy and maintenance therapy.
(2) Obsessive-compulsive disorder
Obsessive-compulsive disorder
Fluvoxamine is a first-line drug for the treatment of obsessive-compulsive disorder, which can be used for the treatment of adult obsessive-compulsive disorder, and can also be used for the treatment of obsessive-compulsive disorder in children and adolescents over 8 years old, and has a good therapeutic effect on obsessive-compulsive thinking and compulsive behavior. The recommended starting dose for fluvoxamine for the treatment of obsessive-compulsive disorder is 25-50 mg / day once a day, taken after dinner, every 2-3 added dose of 50 mg, gradually increasing to the target dose; The usual dose is 100-300 mg/day.
(3) Anxiety disorders
Anxiety disorders
Fluvoxamine significantly reduces anxious behavior in patients and improves social and occupational functioning, and is the first serotonin reuptake inhibitor approved to treat social anxiety disorder. The common dose of fluvoxamine for the treatment of social anxiety disorders is 100-300 mg / day.
(4) Schizophrenia
Fluvoxamine can be combined with clozapine to treat schizophrenia, especially refractory schizophrenia, which can significantly improve residual negative symptoms and depressive symptoms; At the same time, fluvoxamine can reduce the clearance of clozapine, increase and maintain the stability of blood concentrations, and enhance the efficacy, which is related to fluvoxamine as a potent inhibitor of CYP1A2.
Reduce mortality
Fluvoxamine can regulate immunity
It may seem inconceivable that a drug for the treatment of mental illness could be used to treat viral infectious diseases, but it is actually related to the complex pharmacological mechanisms of fluvoxamine. Studies have found that the excessive inflammatory response caused by the new coronavirus leads to lung damage, which in turn aggravates the deterioration of the condition and even death. In order to prevent the damage of the new crown virus to the lungs, regulating the body's immune response is a key step, and the σ-1 receptor is the key mechanism for regulating human immunity, fluvoxamine has a high affinity for S1R, has a certain immunomodulatory effect, which is also an important pharmacological basis for the use of fluvoxamine for the treatment of new coronavirus infection.
(1) It is usually not recommended during pregnancy, especially in the first 3 months of pregnancy, but no evidence of damage to the embryo was found with fluvoxamine. Fluvoxamine can be secreted in very small amounts through breast milk and has little effect on infants.
(2) Patients with liver function impairment are recommended to reduce the dose or reduce the number of medications taken, possibly half of the usual dose; Patients with impaired renal function do not have to adjust the dose.
(3) Fluvoxamine is a strong inhibitor of CYP4501A2, a moderate inhibitor of CYP3A4, CYP2C9/2C19, and is shared with drugs that rely on isoenzyme metabolism clearance, which can lead to a prolonged clearance cycle of these drugs, increase blood drug concentrations, and the need to reduce the dose of combined drugs. Common drugs include clozapine, olanzapine, clopidogrel, propranolol, amlodipine, carbamazepine, alprazolam, diazepam, simvastatin, atorvastatin, etc.
(4) Fluvoxamine should be avoided from sharing with the following drugs: cisapride, linezolid, pimozide, sumatriptan, selegiline, tizanidine, diazepam, caffeine.
(5) Fluvoxamine has fewer adverse reactions, and the most common adverse reactions are gastrointestinal symptoms, which are manifested as nausea
, dry mouth, constipation, diarrhea and loose stools, mild symptoms can not be treated, after half a month can disappear on their own, it is recommended that the drug and food to take together, most patients gastrointestinal symptoms can be alleviated.
Although there is high-level evidence that fluvoxamine can reduce the risk of death in patients with new crown, this study still has limitations, such as differences between different populations, differences between different conditions, safety and other important factors are not clear, so more research is still needed in the future, but from the available evidence, fluvoxamine is very cost-effective, fluvoxamine a course of treatment costs about 4 US dollars, so many poor countries can always access this drug, thereby saving more lives.
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