作者认为，尽管 FDA 尚未批准 Fluvoxamine 用于治疗 COVID-19，但一项名为 TOGETHER 的大型临床试验表明，Fluvoxamine 能够有效降低 COVID-19 患者的住院率。作者认为，鉴于 Fluvoxamine 是常见的 SSRI 抗抑郁药，其安全性已被广泛研究，并且其副作用与其他 SSRI 相似，FDA 应该认真考虑批准 Fluvoxamine 用于治疗 COVID-19。

😄 **Fluvoxamine 在 TOGETHER 试验中表现出色：**TOGETHER 试验是一项大型临床试验，旨在测试各种潜在的 COVID-19 早期治疗方法，包括羟氯喹和伊维菌素。结果显示，Fluvoxamine 能够有效降低 COVID-19 患者的住院率，大约 30%。

🤔 **Fluvoxamine 是常见的 SSRI 抗抑郁药：**Fluvoxamine 是一种常见的 SSRI 抗抑郁药，其安全性已被广泛研究。其副作用与其他 SSRI 相似，并且已经被广泛使用，每年有 3000 万人服用 SSRI，约占美国人口的 10%。

🤨 **Fluvoxamine 的副作用风险较低：**作者认为，Fluvoxamine 的副作用风险较低，尤其是短期服用低剂量的情况下。作者引用了 VA 系统在 2011 年对 35,000 名高风险老年患者进行的试验，该试验发现，停止服用 Fluvoxamine 并没有减少长 QT 综合征的发生率。

💡 **Fluvoxamine 可能是有效的 COVID-19 治疗方法：**作者认为，鉴于 Fluvoxamine 的安全性已经被广泛研究，并且其在 TOGETHER 试验中表现出色，FDA 应该认真考虑批准 Fluvoxamine 用于治疗 COVID-19。

https://astralcodexten.substack.com/p/the-fda-has-punted-decisions-about

 

I.

Here’s my pitch for fluvoxamine (Luvox) for COVID.

In the midst of all the hype about ivermectin and hydroxychloroquine, scientists put together the giant 4,000-person TOGETHER trial, intended to test all these exciting COVID early treatments. You know what happened next: ivermectin and hydroxychloroquine crashed and burned.

But a different drug, the SSRI antidepressant fluvoxamine, actually did really well! It decreased COVID hospitalizations by about 30% - not the perfect cure rate the rumors attributed to ivermectin, but a substantial decrease. Given the size and professionalism of this study, and another smaller one that also got positive results, I and many others take Luvox pretty seriously. At this point I’d give it 60-40 it works.

Can you prescribe a medication when you’re only 60% confident in it? There’s some thorny philosophical issues around this, but I think in the end you have to compare risks and benefits.

What are the risks? Like every medication, including Tylenol, aspirin, etc, Luvox has some common minor side effects and some rare major ones. But let’s step back a second. Fluvoxamine is a bog-standard SSRI. Its side effects are generic SSRI side effects. We give SSRIs to 30 million people a year, or about 10% of all Americans. As a psychiatrist, I’m not supposed to say flippant things like “we give SSRIs out like candy”. We do careful risk-benefit analysis and when appropriate we screen patients for various risk factors. But after we do all that stuff, we give them to 10% of Americans, compared to 12% of Americans who got candy last Halloween. So you can draw your own conclusion about how severe we think the risks are.

For some reason the same experts who don’t mind prescribing SSRIs when people have mild depression freak out about prescribing them when they’re the only evidence-based oral medication for a deadly global pandemic. “What about SSRI withdrawal?”, they ask. After a ten day course? On 100 mg imipramine-equivalent dose? Minimal. “What about long QT syndrome?” The VA system took 35,000 high-risk older patients off of an unusually-likely-to-cause-QT-syndrome SSRI in 2011, and were unable to find any evidence that this prevented even a single case of the syndrome, let alone any negative outcome!