Steven Lippmann, M.D.

The coronavirus pandemic caused us some hard times – disruption, devastation, and death. Despite a recent rise in COVID-19 disease incidence, there is a general feeling that the illness is diminishing.

There are countermeasures to mitigate its severity: several vaccines, monoclonal antibody therapies, and antiviral agents. Vaccines can induce some immunity, monoclonal antibody drugs impair virus cell entry, and antiviral drugs mitigate intracellular virus replication. Vaccines are the primary, most effective means of disease prevention.

The antidepressant drug, fluvoxamine, was recently discovered to have antiviral properties, countering coronavirus infections. Welcome news, another treatment option. Significant, too, is that fluvoxamine is safe and vastly cheaper than any coronavirus remedy.

Morbidity and mortality from COVID-19 often follows SARS-CoV-2 virus infection development of a hyper-inflammatory cytokine storm. It seems that fluvoxamine has anti-inflammatory properties at mitochondria, as one mechanism of action. This normalizes metabolic activity and facilitates cell survival. The drug also might induce antiplatelet actions, diminish histamine release, have other anti-viral actions, and moderate stress during viral replication. Thus, fluvoxamine attenuates coronavirus illness severity.

Research evidenced less respiratory illness in patients who received fluvoxamine at 100 mg daily. Subsequent investigations confirm such progress while prescribing fluvoxamine at 100 mg twice daily for 10 days. The treatment evidenced efficacy; however, reduced mortality did not reach statistical significance.

The good news: this widely available medication is already approved for use with a good safety record. The bottom line: fluvoxamine is inexpensive, and it diminishes patient’s COVID-19 severity, morbidity, and mortality.

Suggested readings

1. Nicol GE, Karp JF, Reiersen AM, et al.  “What were you before the war?” J Clin Psych. 2020; 81(3):20com13373.
2. Hayashi T, Su TP. Sigma-1 receptor chaperones at the ER-mitochondrion interface regulate Ca (2+) signaling and cell survival. 2007;131:596–610.
3. Sukhatme VP, Reiersen AM, Vayttaden SJ, Sukhatme VV. Fluvoxamine: A Review of Its Mechanism of Action and Its Role in COVID-19. Front Pharmacol. 2021;20:12:652688.
4. Lenze EJ, Mattar C, Zorumski CF, et al.Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized Clinical Trial. J Am Med Assoc. 2020;324(22):2292-2300.
5. Reis G, Dos Santos Moreira-Silva EA, Silva DCM, et al. Effect of early treatment with fluvoxamine on risk of emergency care and hospitalization among patients with COVID-19: The together randomized, platform clinical trial. Lancet Glob Health. 2022;10(1):e42-e51.