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The symptoms of fluvoxamine overdose include somnolence, diarrhea, vomiting, and dizziness. In a case series of 354 fluvoxamine overdoses, at least 309 patients recovered fully after gastric decontamination and supportive care. A patient fully recovered after ingesting 10,000 mg of fluvoxamine. Unfortunately, 19 patients died; however, 17 combined fluvoxamine with other medications. Therefore, the contribution of fluvoxamine was not confirmed.[2] Signs and Symptoms Commonly reported adverse effects (occurring in ≥5% of overdose cases) include coma, hypokalemia, hypotension, nausea, dyspnea, somnolence, tachycardia, and vomiting. Additional symptoms that have been observed, either with fluvoxamine alone or in combination with other substances, include bradycardia, electrocardiogram abnormalities, such as cardiac arrest, prolonged QT interval, first-degree atrioventricular nodal block, bundle-branch block, and junctional rhythm; seizures; tremors; diarrhea; and hyperreflexia. Management of Overdose Treatment should follow standard procedures used for antidepressant overdoses. Priority should be given to maintaining respiratory function, ensuring adequate oxygenation, and supporting ventilation. Vital signs and cardiac rhythm should be continuously monitored. General supportive care and symptom-based treatment are advised. Inducing vomiting is not recommended. Gastric lavage may be considered with a large-bore orogastric tube if performed shortly after ingestion or if the patient is symptomatic, provided aspiration precautions are in place. Activated charcoal should be administered to reduce the absorption of drugs. Because fluvoxamine has a large volume of distribution, procedures such as forced diuresis, dialysis, hemoperfusion, or exchange transfusion are unlikely to be effective. There is no known antidote for fluvoxamine overdose. Caution is required if the patient is also taking or has recently taken a tricyclic antidepressant, as fluvoxamine can increase the levels and effects, potentially leading to worse outcomes. In overdose, coingestion should be considered. A poison control center should be consulted for detailed guidance.

OCD causes significant distress in patients and impacts their daily living, relationships, and employment. Collaboration between clinicians, therapists, pharmacists, and other healthcare professionals is necessary to treat these patients appropriately. Behavioral therapy, such as exposure and response prevention, is the first-line treatment for reducing compulsions in approximately 50% of patients with OCD; benefits may persist for 2 years.[25][26] Results from a high-quality systematic review and meta-analysis demonstrate that fluvoxamine is more effective than placebo in improving symptoms and response rates for OCD and social anxiety disorder, with mixed findings in panic disorder.[27] The best patient outcomes combine medication treatment, such as fluvoxamine, with psychotherapy to help ease obsessions and compulsions. Because relapse after treatment discontinuation is common, continued treatment is advised. Fluvoxamine is a safe medication for patients in the hospital with stable vital signs, normal electrocardiogram results, and normal laboratory test results. Fluvoxamine can be used as an off-label medication to help treat patients with anxiety, depression, or panic disorder, which can improve outcomes for patients with prolonged hospital stays or procedures that cause distress.[14]

The best patient outcomes combine medication treatment, such as fluvoxamine, with psychotherapy to help ease obsessions and compulsions. Because relapse after treatment discontinuation is common, continued treatment is advised. Fluvoxamine is a safe medication for patients in the hospital with stable vital signs, normal electrocardiogram results, and normal laboratory test results. Fluvoxamine can be used as an off-label medication to help treat patients with anxiety, depression, or panic disorder, which can improve outcomes for patients with prolonged hospital stays or procedures that cause distress.[14] Effective use of fluvoxamine in clinical practice requires a coordinated, interprofessional approach to ensure safe, patient-centered care. Clinicians diagnose OCD and depression, determining the appropriateness of fluvoxamine therapy, and educate patients about potential benefits and risks. Nurses contribute by monitoring adherence, assessing for adverse effects such as serotonin syndrome, and identifying behavioral changes that may signal worsening depression or suicidality—especially during treatment initiation or dose adjustments. Pharmacists assess drug-drug interactions, particularly given fluvoxamine's potent inhibition of the CYP1A2, CYP2C19, and CYP3A4 enzymes, which can significantly impact the metabolism of many medications, and counsel patients on dosing, titration, and withdrawal strategies.[28] Mental healthcare professionals, including therapists and social workers, improve outcomes by addressing the psychosocial needs of patients and reinforcing therapeutic engagement. Clear interprofessional communication, ongoing safety monitoring, and shared decision-making foster a collaborative care environment. By aligning roles and responsibilities, the healthcare team can optimize treatment with fluvoxamine, improve symptom control, minimize adverse effects, and enhance quality of life.