Fluvoxamine and COVID-19: Here’s How the OCD Drug Might Help Prevent COVID-19 Infections From Getting Worse

The COVID-19 vaccine rollout has been the main focus of attention over the last few months—more than 90 million doses have been administered since distribution began on December 14, 2020 at a rate of more than 2.2 million shots per day. But at the same time, scientists have continued to work hard to find treatments for people who get infected.
Fluvoxamine and COVID-19
One of them, the generic drug fluvoxamine, has shown huge potential. Developed 40 years ago as an antidepressant, fluvoxamine—sometimes known as Luvox—has been used mainly to treat obsessive-compulsive disorder (OCD), per the National Alliance on Mental Illness (NAMI). But now, researchers are taking a closer look at how the medication could be an important treatment to prevent patients who test positive for COVID-19 from getting seriously ill with the infection.

In a new interview with 60 Minutes, Angela Reiersen, MD, a child psychiatrist at Washington University in St. Louis—and co-author of a November 2020 study published in the Journal of the American Medical Association (JAMA) regarding the use of fluvoxamine in COVID-19 patients—explained that she first got the idea that the drug could potentially treat COVID-19 after seeing research that fluvoxamine prevented sepsis in mice.

"I thought, well, I wonder if we could use fluvoxamine to treat COVID and prevent that clinical deterioration," Dr. Reiersen told 60 Minutes.

Dr. Reiersen and her colleagues—including Eric Lenze, MD, a fellow psychiatrist at Washington University who also specializes in finding new uses for drugs that are already approved by the Food and Drug Administration (FDA)—went on to conduct the small randomized clinical trial on fluvoxamine and COVID-19 patients.

The results of that JAMA study found that participants with symptomatic COVID-19 who were treated with fluvoxamine "had a lower likelihood of clinical deterioriation" than those who were given a placebo. "The results were really pretty incredible," Dr. Lenze told Alfonsi. "Out of the 80 people who received fluvoxamine, none, zero of them deteriorated versus 8% of the people who got [the] placebo."

Of course, since the study was only preliminary, researchers declared that more research was needed to determine "clinical efficacy" of the drug in COVID-19 patients. But that research sparked even more research on fluvoxamine's role in preventing serious disease in those with COVID-19 infections.

David Seftel, MD, a physician in Berkeley, California, opted to offer a 15-day prescription to his own COVID-19 patients, who fell victim to an outbreak in the Golden Gate Fields race track community. (FYI: His decision to use a prescription drug off-label is an accepted medical practice, provided the patient consents. "Off-label" simply means it hasn't been approved by the FDA for that particular condition.) 

The results of Dr. Seftel's real world study, which were published in , showed that, of 65 of those patients who chose to take fluvoxamine, none were hospitalized, while of the 48 who declined the prescription, 12.5% ended up hospitalized, and one died. Experts believe fluvoxamine has shown to be effective against COVID-19 due to the medication's effects on the body's inflammatory response—specifically by tamping down that response in those with active COVID-19 infections.

  Normally, when the body is trying to fight off an invader like SARS-CoV-2 (the virus that causes COVID-19), it releases cytokines, or biological chemicals that stimulate cell pathways and allow for communication between cells. Those cytokines signal to the body's immune system that it needs to start doing its job. In some cases, though, the the outpouring of cytokines becomes accelerated—known as a cytokine storm—creating high levels of inflammation in the body. "Normally, cytokines are meant to be helpful to us in moderation," Carl Fichtenbaum, MD, professor in the division of infectious diseases at the University of Cincinnati College of Medicine, previously told Health, "but when a certain pathway is engaged [too much] the immune system starts causing damage to the patient."

This is where researchers think fluvoxamine comes into play. Though the drug typically works by increasing the amount of serotonin in the body, it also binds to and activates sigma-1 receptors, which may help reduce cytokine production in the body, according to a research article in Science Translational Medicine (this one, looking at patients with sepsis), and ultimately decrease the sometimes deadly inflammation that can occur in COVID-19 patients. 

 Though more research is still needed on the effects of fluvoxamine in COVID-19 patients—and yet another study led by Dr. Lenze is currently underway—when asked on if the positive results could have been a fluke, Dr. Seftel said, "I don't believe so. You cannot influence a virus that is as wily and as wicked as COVID with a fluke."

Francis Collins, MD, PhD, the director of the National Institutes of Health (NIH), told Alfonsi that "fluvoxamine could certainly be something you wanna put in the tool chest [because] it looks as if it has the promise to reduce the likelihood of severe illness."

Although the vaccine rollout is greatly reducing the number of people who get seriously ill and are hospitalized with COVID-19, no vaccine offers 100% protection, and new mutations of the virus are appearing all the time. So it's still important to find new treatments for the illness. With more research, we'll have a clearer idea of the part fluvoxamine may play.

Fluvoxamine and FLCCC I-MASK+ Protocol

Front Line COVID-19 Critical Care Alliance (FLCCC) Releases Updated Protocols for More Effective Treatment of COVID-19. Please refer to the latest FLCCC protocol (August 11, 2021 version). Now updated to include three additional drug treatments as well as a higher dose and frequency of ivermectin, the protocols become even more powerful weapons in the fight against the COVID-19 pandemic. Added to the protocols is the use of Fluvoxamine. Largely known as an antidepressant, Fluvoxamine has strong anti-inflammatory properties that have been shown in two trials to be highly effective against the inflammation caused by COVID-19.

Note about TOGETHER trial results for fluvoxamine and ivermectin

Why did Ivermectin seem to fail and Fluvoxamine not do so well? 

According to Steve Kirsch:

Ivermectin was dosed for 3 days; fluvoxamine for 10 days.

We don't think the trial was gamed at all. I think this was a legit result.

We know the Principal Investigator Edward Mills and believe he is totally honest and we have no reason not to believe the results he obtained. But we also believe other researchers as well.

So the question everyone has is how could these drugs do so well in other studies?

The answer: the variant was different. P1 is the variant in Brazil and makes Delta look like a walk in the park. If you do not treat P1, instantly upon symptoms, you will see big failures.

Had fluvoxamine been given on Day 0 instead of Day 4, there would have been a dramatically different result.

Had ivermectin been dosed at 0.6mg/day for 14 days starting on Day 0 (the first day of symptoms), there would have been a dramatically different result.

The more aggressive the variant, the earlier and harder you have to treat it.

Ivermectin likely failed for these four reasons:
  • too little a dose
  • started too late
  • not continued for long enough
  • many patients may have already been taking ivermectin
Those are the 3 biggest reasons. The healthcare systems need to encourage people to have the meds in the cabinet for immediate use. Nobody does that. That's why we have a problem.

Also, you can't treat Delta and P1 in the hospital... it is much much tougher there. It's like a fire department arriving when the entire building is in flames. 

Fluvoxamine vs Other Options

The recommendations below are based on both scientific studies and the experience of clinicians in treating COVID-19.

There are many drugs and supplements that have varying levels of positive effectiveness against the virus including inhaled budesonide, bromhexine, vitamin D, and HCQ. All of these have the greatest value when started as early as possible. There is no benefit to waiting. In general, these drugs (and supplements) are safe with very low side-effect profiles. Your doctor may recommend adding one or more of these drugs at the start of treatment in addition to ivermectin and fluvoxamine. For patients with severe or worsening respiratory symptoms, 4-8 mg cyproheptadine 3-4 times a day has been shown to be very helpful as well.

The combination of ivermectin and fluvoxamine is extremely effective when used ASAP. Two of the most effective drugs to treat Covid early are ivermectin and fluvoxamine. Both drugs should be started together at the same time. If you are treated within 48 hours of first symptoms, research shows that ivermectin should be given at a dose of 0.4mg/kg for a minimum of 5 days or until symptoms resolve, whichever is later. Fluvoxamine should be given as 50 mg twice a day for 14 days. The website www.c19early.com shows that these are the two approved drugs which individually have shown to be the most effective against Covid in two or more studies. Used together, these drugs have no common adverse interactions and have complementary mechanisms of action. For instance, fluvoxamine is a potent anti-inflammatory and, because it is able to penetrate the blood-brain barrier, it is effective in preventing inflammation in your brain. Unlike systemic steroids, fluvoxamine does not impair your ability to fight the virus so it can be used immediately. The fluvoxamine dose effective against Covid is just one third of the FDA-approved dose so side effects are very rare and minimal. I am not aware of anyone who started both drugs within 48 hours of first symptoms who didn’t have a rapid recovery. The best method to catch the virus early is to test regularly, and start treatment upon a positive test. This is because the PCR test can detect Covid before symptoms start.

If fluvoxamine isn’t available, fluoxetine is a viable substitute (Scientific Reports 2021). All the data we’ve seen shows that if you can’t get fluvoxamine, using 30mg once a day of fluoxetine (Prozac) is equally effective (equivalent to 50mg twice a day of fluvoxamine).

Fluvoxamine is in top position as a treatment against COVID-19 >

Credit: C19early.com

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References: 
The information in this article is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. We encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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