fluvoxamine and Multiple-Sclerosis

Tizanidine, one of the few oral antispastic therapies approved for use in the USA, has a narrow therapeutic index that can often make optimal patient dosing difficult. We surveyed the published literature for data on potential tizanidine dose relationships to pharmacokinetics, drug safety and effectiveness, as well as to provide practical drug dosing advice.. The number of primary studies that describe tizanidine dose proportionality relationships was somewhat limited, even when including studies that used doses above those currently recommended or data from drug-drug interaction studies that resulted in supra-therapeutic tizanidine concentrations.. There is substantial evidence to show that plasma tizanidine concentrations are linearly related to dose in healthy subjects and patients, although there is a high degree of intersubject variability. The most common adverse events and pharmacodynamic effects are related to plasma concentrations. The clinical implications of the large interpatient variability in plasma tizanidine concentrations and its narrow therapeutic index make it necessary to individualise patient therapy. Practical advice on tizanidine dosing and/or switching between formulations is provided.

Topics: Chemistry, Pharmaceutical; Ciprofloxacin; Clonidine; Dose-Response Relationship, Drug; Drug Interactions; Fluvoxamine; Humans; Multiple Sclerosis; Muscle Relaxants, Central; Treatment Outcome

Fluvoxamine 200 mg was administered for 3 months to a group of 43 interferon beta-1b treated patients affected by major depression associated with multiple sclerosis. Despite a 16.3% attrition rate, 79% of patients achieved response. The drug was well tolerated.

Topics: Adjuvants, Immunologic; Adult; Depressive Disorder, Major; Drug Administration Schedule; Female; Fluvoxamine; Follow-Up Studies; Humans; Interferon beta-1b; Interferon-beta; Male; Mental Status Schedule; Middle Aged; Multiple Sclerosis; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Treatment Outcome

Emotional lability may be a part of the syndrome of pseudobulbar palsy. Here we report our experience with fluvoxamine, a selective serotonin reuptake inhibitor, used to treat 10 patients with emotional incontinence. Over a 7-month period, we studied and treated 10 consecutive patients (mean age, 61 +/- 8 years) attending our department: four had amyotrophic lateral sclerosis (progressive bulbar palsy form), four had clinically definite multiple sclerosis, and two had had strokes. They were given a single evening dose (100 mg) of fluvoxamine. All 10 patients had > 30 affective outbursts daily. It was observed that in 2 to 6 days, all the patients improved, the number of emotional outbursts dropping to none to five per day. This result suggests that the serotoninergic system may be implicated in emotional lability. The short latency of improvement we observed in our patients suggests that the mechanism of fluvoxamine for treating emotional lability differs from its mechanism for treating affective disorders.

Topics: Affective Symptoms; Aged; Amyotrophic Lateral Sclerosis; Female; Fluvoxamine; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Sclerosis; Selective Serotonin Reuptake Inhibitors; Tomography, X-Ray Computed

Topics: Anti-Anxiety Agents; Cognition Disorders; Epilepsy; ERG1 Potassium Channel; Ether-A-Go-Go Potassium Channels; Female; Fluvoxamine; Humans; Long QT Syndrome; Middle Aged; Multiple Sclerosis; Obsessive-Compulsive Disorder; Potassium Channel Blockers; Schizophrenia; Selective Serotonin Reuptake Inhibitors; Treatment Outcome