Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) which is being trialed for possible therapeutic use in COVID-19.

Fluvoxamine, via agonism of the sigma-1 receptor, has shown benefit in animal models of septic shock.

COVID-19 clinical trials

Fluvoxamine showed promise in a randomized, placebo-controlled trial of 152 COVID-19 positive outpatients.  In a paper published in November, 2020 in the Journal of the American Medical Association:

Clinical deterioration occurred in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group (absolute difference, 8.7% [95% CI, 1.8%-16.4%] from survival analysis; log-rank P = .009). The fluvoxamine group had 1 serious adverse event and 11 other adverse events, whereas the placebo group had 6 serious adverse events and 12 other adverse events. -JAMA

In a prospective cohort study of fluvoxamine for an outbreak at the Golden Gate Fields racetrack:

Overall, 65 persons opted to receive fluvoxamine 50mg twice daily and 48 declined. Incidence of hospitalization was 0% (0/65) with fluvoxamine and 12.5% (6/48) with observation alone. At 14 days, residual symptoms persisted in 0% (0/65) with fluvoxamine and 60% (29/48) with observation.

More on the Golden Gate Fields outbreak can be found in this Berkeleyside article.

Trials in progress 

The skeletal formula of fluvoxamine.

Clinical Guidelines

Fluvoxamine in NIH CVOID-19 treatment guidelines. https://www.covid19treatmentguidelines.nih.gov/therapies/immunomodulators/fluvoxamine/

Mechanism of possible benefit?

Sigma-1 receptor

Mechanisms of potential benefit in COVID-19 may include sigma-1 receptor agonism.  See "Fluvoxamine alleviates ER stress via induction of Sigma-1 receptor" and "Modulation of the sigma-1 receptor–IRE1 pathway is beneficial in preclinical models of inflammation and sepsis".

As an antidepressant

An observational study of 7,345 hospitalized COVID-19 patients hinted at possible benefit of prior antidepressant usage.

As an anti-viral

In an October, 2020 preprint, fluoxetine, a related SSRI, showed in vitro anti-SARS-CoV-2 activity in Vero and Calu-3 cells.

Other methods of possible benefit

There is speculation that fluovamine may have benefits in COVID-19 by increasing nighttime plasma levels of melatonin.

News coverage

Notes on side effects & interactions

Fluvoxamine does not play well with caffeine — it makes a cup of coffee last 31-35 hours instead of 5 (see also and also). For more information on potential interactions see:

See also