Why do I need this medicine? Fluvoxamine is used to treat depression and obsessive-compulsive disorder (a disorder characterised by an uncontrollable urge to do repetitive and ritualised behaviours). How do I take this medicine? Take Fluvoxamine exactly as directed by your doctor or according to the instruction on the label. Do not take more or less than instructed by your doctor. You may take this medicine with or without food. Try to take it at the same time each day. Fluvoxamine is available as a conventional tablet or an extended-release tablet. If you are taking the conventional tablet, swallow it whole with a glass of water. You may break the tablet(s) in half if you are advised to by your doctor. Do not chew the tablet. If you are taking the extended-release tablet (usually labelled as “ER” or “XR”), swallow it whole. Do not divide, chew or crush the tablet. The dose of this medicine will be decided by your doctor. Your doctor will advise you on the treatment timeframe depending on your response to the medication. Fluvoxamine must be taken regularly for it to be effective. Continue taking this medicine even when you feel better. Do not stop taking it unless instructed otherwise, as stopping it suddenly could worsen your condition. Your doctor will gradually reduce the dose before stopping it. What should I do if I have forgotten to take this medicine? Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and return to your normal dosing schedule. Do not double dose under any circumstances. If you often forget to take your medicine, let your doctor and pharmacist know. When should I not use this medicine? Alert your doctor if you have unstable fits or seizures as Fluvoxamine may not be suitable for you. Do not breastfeed while you are being treated with this medicine. Do not take Fluvoxamine with medicines used to treat depression known as monoamine oxidase inhibitors (MAOIs), medicines for mood disorder, cold or allergy, sleep disorder, blood disorder, muscle relaxation, and certain antibiotics or gastric medicines. Please see the section “Can I take it with other medicines?” below for more information. What should I take note of while taking this medicine? Inform your doctor if you have the following conditions: bipolar disorder (mood changes between feeling very high and very low) history of mania (feeling highly excited, being over-active and easily irritated or distracted) with or a history of epilepsy (fits or seizures) heart disease e.g. recent heart attack previous bleeding problems with or at risk of glaucoma (increased pressure in the eye) low blood volume circulating in the body smoking diabetes kidney disease liver disease Let your doctor know if you are pregnant. Be sure to check with your doctor or pharmacist before giving this medicine to an elderly. Notify your doctor if you have recently undergone electroshock therapy (also known as electroconvulsive therapy or ECT). Medicines for depression such as Fluvoxamine may increase the risk of suicidal thoughts and behaviour. As depression and some psychiatric disorders are themselves associated with an increased risk of suicide, it is important for you or your family members to monitor your condition especially at the start of treatment and if your dosage is still being adjusted. If you experience new or sudden changes in mood, behaviour, thoughts or feelings or a worsening of your depression with suicidal thoughts or attempts, harm to self or harm to others, contact your doctor immediately. A certain enzyme called CYP2D6 is involved in the breakdown of this medicine in the body. Individuals who are known as poor metabolisers of CYP2D6 may experience enhanced side effects of Fluvoxamine (e.g. difficulty sleeping, headache) that may require dose adjustments. Although not routinely done, your doctor may advise you to undergo genetic testing to check if this medicine is best suited for you. If you know you have this gene type, inform your doctor. Keep your appointments with your doctor. Your doctor needs to monitor your condition and check your response to the medication regularly. Your doctor may need to perform blood tests to make sure that your liver function is normal before you take this medicine and thereafter depending on your doctor’s advice. Your doctor will advise you about how often you need to have these tests. It is important for you to monitor your condition especially at the start of treatment and when your dosage is being adjusted. Monitor for any unusual changes in your behaviour or mood while you are being treated with this medicine. What lifestyle changes should I make to cope with depression? Regular exercise and eating a healthy diet will help increase energy and hormones in the body such as serotonin, endorphins and other feel-good chemicals that minimise mood swings. Get enough sleep, as lack of sleep may cause irritability, moodiness, sadness, and tiredness. What side effects could I experience? Fluvoxamine may cause you to suddenly fall asleep during your daily activities such as eating and watching television. Do not drive or take part in any activity in which you need to be alert. Other side effects include any of the following: headache, dizziness, dry mouth, constipation, nausea, vomiting, diarrhoea, indigestion, loss of appetite, joint or muscle pain, difficulty sleeping, increased sweating, and weakness. Some side effects may need immediate medical help. Alert your doctor quickly if you experience any of the following: having thoughts of self-harm unusual changes in mood or behaviour (being too depressed, irritable, aggressive, anxious or having compulsive and impulsive behaviour) muscle stiffness or spasms, fever, confusion, extreme agitation feelings of restlessness, unable to sit or stand still, or need to move often fits or seizures changes in sex drive unusual bleeding or bruising rashes, breathlessness, swollen mouth or eyes Inform your doctor if any of these side effects do not go away or are severe, or if you experience other side effects. Can I take this with other medicines? Do not take Fluvoxamine if you are currently taking or have taken medicines to treat depression known as monoamine oxidase inhibitor (MAOI) such as moclobemide, isocarboxazid, phenelzine and tranylcypromine or within 14 days of stopping the MAOI. Do not take this medicine if you are taking or using any of the following medicines: medicines for mood disorders e.g. pimozide, thioridazine gastric medicines e.g. cisapride, alosetron medicines for cold or allergy e.g. terfenadine, astemizole tizanidine (muscle relaxant) linezolid (antibiotic) injectable methylene blue (medicine for certain blood disorder) Inform your doctor and pharmacist if you are taking any of these medicines: other medicines for depression e.g. amitriptyline, clomipramine, imipramine medicines for mood disorders e.g. lithium, clozapine, olanzapine, quetiapine medicines for sleep disorders e.g. midazolam, triazolam, alprazolam, diazepam medicines for epilepsy (fits or seizures) e.g. phenytoin, carbamazepine blood-thinning medicines e.g. clopidogrel, warfarin, ticlopidine strong painkillers e.g. fentanyl, tramadol, methadone NSAIDs (medicines for pain and inflammation) e.g. aspirin, ibuprofen medicine for migraine e.g. sumatriptan medicine for high blood pressure e.g. propranolol asthma medicine e.g. theophylline medicine for Parkinson’s disease e.g. ropinirole herbal supplement (St. John’s wort) This list does not include all medicines that interact with Fluvoxamine. Always notify your doctor and pharmacist if you are taking any other medicines, including herbal tonics such as traditional Chinese medicines, supplements and medicines that you buy without a prescription. What special dietary instructions should I follow? Avoid alcohol and caffeine-containing beverages such as coffee, tea and certain soft drinks. How should I store this medicine? Store in a cool, dry place away from the reach of children. Protect from high humidity. Medicines must not be used past the expiry date.

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