clozapine + fluvoxamine

Clozapine + fluvoxamine is a combination of two pharmaceutical drugs used primarily in the management of treatment-resistant schizophrenia. Clozapine is an atypical antipsychotic that acts as an antagonist at dopamine D2, serotonin 5-HT2A, and several other neurotransmitter receptors. Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) and sigma-1 receptor agonist, mainly indicated for obsessive-compulsive disorder but also used off-label to augment clozapine therapy. The rationale for combining these drugs lies in their pharmacokinetic interaction. Fluvoxamine potently inhibits cytochrome P450 1A2 (CYP1A2), the primary enzyme responsible for metabolizing clozapine. This inhibition increases plasma concentrations of clozapine and raises the ratio of clozapine to its metabolite norclozapine (N-desmethylclozapine), potentially allowing lower doses of clozapine to achieve therapeutic levels while reducing some adverse effects associated with higher doses or norclozapine exposure[1][3][4][5]. Clinically, this strategy may improve persistent negative symptoms, anxiety, or obsessive-compulsive symptoms in patients unresponsive to standard antipsychotic regimens[1][3].

Other names

clozapine and fluvoxamineclozapine/fluvoxamine combination