Jump to content

Talk:Fluvoxamine

Page contents not supported in other languages.
From Wikipedia, the free encyclopedia

This is an old revision of this page, as edited by 91.159.191.233 (talk) at 22:56, 17 January 2022 (→Elimination half-life. 12-13 hours for single dose, 22 hours for repeated dosing). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.


Information on use for treating COVID

All the information I added on the FLV use in COVID on December 23 was removed shortly thereafter. Yet the information was all based on reliable sources including a JAMA article which has been viewed over 120,000. How is that not relevant medical information? All the other sources are reliable medical information, or are directly from recognized experts, and nothing there was not supported by solid scientific evidence. This is a huge disservice to the world to remove this, so I am baffled by the removal. Please explain the benefit to removing this lifesaving information. Thanks!

Stkirsch (talk) 08:36, 24 December 2020 (UTC)[reply]

We need WP:MEDRS sources. PMID 33180097 is primary research. Alexbrn (talk) 08:42, 24 December 2020 (UTC)[reply]
What an obtuse, intractable standard. This isn't speculative science; these effects are being replicated as we speak. Let's at least allow language on the wiki that acknowledges the preliminary nature of these trials whilst maintaining the central claim that Luvox has demonstrated noteworthy effects. Frevangelion (talk) 15:19, 4 February 2021 (UTC)[reply]
Could we, perhaps, treat it as a media phenomenon and reflect in the Society and culture section? Something along the lines: media promotes fluvoxamine for the treament of COVID-19, while not a single double blind trial has been run.The Sceptical Chymist (talk) 00:29, 7 February 2021 (UTC)[reply]
Never mind. I'v found a JAMA editorial and will use it for the framework.The Sceptical Chymist (talk) 00:29, 7 February 2021 (UTC)[reply]

Whoops, my mistake. Boy, that's a real shame. Stkirsch (talk) 20:01, 24 December 2020 (UTC)[reply]

  • [1] Another study, primary source yada yada. Abstract: "We report a real-world experience using fluvoxamine for coronavirus disease 19 (COVID-19) in a prospective cohort in the setting of a mass outbreak. 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." 2602:24A:DE47:BB20:50DE:F402:42A6:A17D (talk) 04:25, 3 February 2021 (UTC)[reply]
Sources are unreliable. Would need WP:MEDRS. Alexbrn (talk) 12:03, 20 March 2021 (UTC)[reply]
Not so. Before overturning the consensus version, please, read the text you are deleting. I strictly followed WP:MEDRS and WP:NOR recommendations.
1. WP:NOR: "In scholarship, a secondary source is a document or recording that relates or discusses information originally presented elsewhere. A secondary source contrasts with a primary source, which is an original source of the information being discussed; a primary source can be a person with direct knowledge of a situation or a document created by such a person." The secondary source is pmid33180115, the authors are JAMA editorial board, no doubt a reliable source.
2. WP:MEDRS: "Text that relies on primary sources should usually have minimal weight, only describe conclusions made by the source, and describe these findings clearly so that all editors even those without specialist knowledge can check sources." (WP:MEDDEF) AND "Primary sources may be presented together with secondary sources." (WP:MEDREV) AND "Using small-scale, single studies makes for weak evidence, and allows for cherry picking of data. Studies cited or mentioned in Wikipedia should be put in context by using high-quality secondary sources rather than by using the primary sources." (WP:MEDANIMAL)
That is exactly what the following text based on the primary source does: "A double-blind controlled study found that fluvoxamine may prevent clinical deterioration in outpatients with symptomatic COVID-19. The study had important limitations: it was run fully remotely; it had a small sample size (150) and short follow-up duration (15 days).[1]" then, the text based on the reliable secondary source follows, setting this in context: "The accompanying editorial noted that, although this study is important enough to choose out of more than 10,000 other COVID-19 related submissions, it "presents only preliminary information [and] the findings should be interpreted as only hypothesis generating; they should not be used as the basis for current treatment decisions." [2]
3. The primary source (authors of the study as reported by a reliable source: University of Virginia Health System), follows confirming the caution from the secondary source: Similarly, the study authors themselves cautioned that "the trial's results should not be treated as a measure of fluvoxamine's effectiveness against COVID-19 but as an encouraging indicator that the drug warrants further testing."[3]
You can argue about some points but you cannot delete it wholesale. 13:46, 20 March 2021 (UTC)
Do not use these unreliable sources for medical content. None of your sources are sufficient. Per the general sanctions in effect for COVID-19, disputed text must not be replaced without consensus, yet you are edit-warring your text in. You have been warned. Alexbrn (talk) 13:54, 20 March 2021 (UTC)[reply]
Would you please respond to my points? The Sceptical Chymist (talk) 14:07, 20 March 2021 (UTC)[reply]
As I said, "None of your sources are sufficient". If there's a review article or better, that would lend sufficient weight and be a strong enough WP:MEDRS. Primary sources and comments don't cut it. If in doubt, raise a query at WT:MED. Alexbrn (talk) 14:09, 20 March 2021 (UTC)[reply]
Please explain why a JAMA editorial is unreliable source. The Sceptical Chymist (talk) 14:32, 20 March 2021 (UTC)[reply]
See WP:MEDASSESS. We are looking for sources near the top of the triangle, not the bottom. Anyway, you have decided to take the edit-warring route trying to force your edit. I have raised a query at WT:MED. Alexbrn (talk) 14:37, 20 March 2021 (UTC)[reply]
That is reasonable when there are such sources. When there are no sources on the top of the pyramid, WP:MEDRS clearly allows using other reliable sources.The Sceptical Chymist (talk) 14:42, 20 March 2021 (UTC)[reply]
When there are no such sources the material is WP:UNDUE because of a lack of reliable coverage. It is not an excuse to use unreliable sources or engage in edit-warring. Alexbrn (talk) 14:45, 20 March 2021 (UTC)[reply]
The weight is properly set by the accompanying JAMA editorial, so it is not WP:UNDUE. Specifically, the editorial states: "The pilot study by Lenze and colleagues3 addresses a critically important question during the pandemic of how to prevent individuals who acquire COVID-19 from deteriorating to serious illness.4 If an effective treatment is found for this key gap in treatment, it will affect the health of millions of people worldwide." and further, "This study by Lenze and colleagues3 presents only preliminary information, and requires confirmation in larger trials. But at the same time, it is a double-blind, placebo-controlled, randomized clinical trial, which is generally considered a design that minimizes bias and can support causal inference."The Sceptical Chymist (talk) 14:51, 20 March 2021 (UTC)[reply]
Editorials are low-quality sources, insufficient for medical content. So too are primary sources. You have edit-warred the poorly-sourced and disputed content against the explicit terms of the COVID general sanctions. Content and behaviour should follow the WP:PAGs. Adding weak content bearing on "the health of millions of people worldwide" is especially problematic, which is precisely why the GS for COVID-19 exist. Alexbrn (talk) 15:03, 20 March 2021 (UTC)[reply]
So, the disagreement is clear. You believe that JAMA editorial is unreliable source, I believe it to be reliable. I just wish you responded to my requests for comments in this thread in February https://en.wikipedia.org/w/index.php?title=Talk:Fluvoxamine&diff=prev&oldid=1004891001 and https://en.wikipedia.org/w/index.php?title=Talk:Fluvoxamine&diff=prev&oldid=1005298989 . You never responded, and I thought we had consensus.The Sceptical Chymist (talk) 15:13, 20 March 2021 (UTC)[reply]
Obviously not, since your content was removed. I sincerely hope you have not been basing medical content more widely through the project based on editorials in your belief they are sufficient sources. Alexbrn (talk) 15:25, 20 March 2021 (UTC)[reply]
You are mixing up something. My content was not removed in February. I twice asked you for comment and you never responded. So I wrote a paragraph and placed into Fluvoxamine article, first time I ever did that. https://en.wikipedia.org/w/index.php?title=Fluvoxamine&diff=prev&oldid=1005303201 The Sceptical Chymist (talk) 15:39, 20 March 2021 (UTC)[reply]
You never "asked" me anything to which I did not respond. I have hundreds of pages on my watch list and don't spend every waking hour monitoring it. The fact I did not notice something last month, does not give you an excuse for WP:EW this month. Your WP:ONUS does not expire after a month, and as the Application Note for the COVID sanctions reminds: "Editors are reminded that the onus is on the editor seeking to include disputed content to achieve consensus for its inclusion. Any content or source removed in good faith and citing a credible policy-based rationale should not be reinstated without prior consensus on the article's talk page." This is basic stuff. Alexbrn (talk) 15:53, 20 March 2021 (UTC)[reply]

FYI. NH2 moiety (tail) of Fluvoxamine mimics the natural antiviral molecule/vitamin called Nicotinamide and is what reduces COVID symptoms by increasing BST2 protein. People that don't understand the science and/or have not had a serious case of COVID should not be promoting this dangerous drug with side effects. — Preceding unsigned comment added by Esserefelice (talk • contribs) 13:37, 27 December 2021 (UTC)[reply]

Suggestions for Additions

This page would benefit from a more substantial "society and culture" section. Are there any societal beliefs, standards, or effects related to fluvoxamine? A section dedication to how one should take fluvoxamine (with or without food, once or twice a day, etc.) would also be beneficial, as well as a section dedicated to the effects of overdose on this medication. There is some information on the website for the National Alliance on Mental Illness that may be useful. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Fluvoxamine-(Luvox) AshMW2000 (talk) 15:31, 24 February 2021 (UTC)[reply]

Dashes

There is, almost invariably, a mixture of ndashes and mdashes (not to mention masquerading hyphens and double-hyphens) in every article of substantial size. Quote (emphasis mine) ... use either unspaced em dashes or spaced en dashes, with consistency in any one article:

  • An em dash is always unspaced (without a space on either side):
Another "planet" was detected—but it was later found to be a moon of Saturn.
  • An en dash is spaced (with a space on each side) when used as sentence punctuation:
Another "planet" was detected – but it was later found to be a moon of Saturn.

--Oblio4 (talk) 04:57, 20 March 2021 (UTC)[reply]

Unconsummated citations

Yuck. Seems I need to bang in a reflist-cite to clear the constipation.

References

  1. ^ Lenze EJ, Mattar C, Zorumski CF, Stevens A, Schweiger J, Nicol GE, Miller JP, Yang L, Yingling M, Avidan MS, Reiersen AM (December 2020). "Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized Clinical Trial". JAMA. 324 (22): 2292–2300. doi:10.1001/jama.2020.22760. PMID 33180097.
  2. ^ Seymour CW, Bauchner H, Golub RM (December 2020). "COVID-19 Infection-Preventing Clinical Deterioration". JAMA. 324 (22): 2300. doi:10.1001/jama.2020.21720. PMID 33180115.
  3. ^ University of Virginia Health System (November 14, 2020). "Antidepressant Fluvoxamine May Prevent COVID-19 Infections From Worsening". SciTechDaily.

— MaxEnt 15:48, 10 September 2021 (UTC)[reply]

Puff claim not in cite

Original:

The tolerance profile also appears to be quite superior than other SSRIs, despite its age.

New:

The tolerance profile is superior in some respects to other SSRIs, particularly with respect to cardiovascular complications, despite its age.[1]

References

  1. ^ "Tolerability and safety of fluvoxamine and other antidepressants". doi:10.1111/j.1368-5031.2006.00865.x. {{cite journal}}: Cite journal requires |journal= (help)

A sweeping "quite superior" is not suitable for Wikipedia, especially in the fragile ecosystem of medical common sense. — MaxEnt 15:47, 10 September 2021 (UTC)[reply]

Efficacy numbers against COVID-19 hospitalization: undue?

@Alexbrn: Why is this data undue? WP:MEDRS clearly says that The best evidence for efficacy of treatments and other health interventions is mainly from meta-analyses of randomized controlled trials (RCTs) and this is an RCT. --Fernando Trebien (talk) 14:40, 20 November 2021 (UTC)[reply]

Because a meta-analysis of an RCT is not an RCT. An RCT is a primary source. We should really be confining ourselves to secondary sources in any case so maybe this would be useful until something better appears. Alexbrn (talk) 14:44, 20 November 2021 (UTC)[reply]
Alright. I thought that including the confidence intervals would help the reader to evaluate the accuracy of these numbers. Maybe we could also mention criticism [2][3] of the study. --Fernando Trebien (talk) 14:58, 20 November 2021 (UTC)[reply]
As it's an unreliable source I don't think it's wise to expose its detail. It might be wrong. Alexbrn (talk) 15:12, 20 November 2021 (UTC)[reply]

In participants who took at least 80% of the pills (2 x 100mg daily for 10 days):

  • Risk of hospitalization or extended emergency care was reduced by 2/3.
  • 1 death among those taking Fluvoxamine compared with 12 deaths in the placebo group, a reduction in mortality risk of 91%.

https://medicine.wustl.edu/news/antidepressant-may-prevent-severe-covid-19-follow-up-study-indicates/

--91.159.189.62 (talk) 19:20, 28 November 2021 (UTC)[reply]

We're still waiting for reliable sources. Alexbrn (talk) 19:21, 28 November 2021 (UTC)[reply]

Additional Covid sources

In previous discussions it appears MEDRS standards on what to prefer have been stretched to require, but in any case, the sources listed here should be suitable to build a fleshed-out article section. Sennalen (talk) 15:53, 13 January 2022 (UTC)[reply]

Elimination half-life. 12-13 hours for single dose, 22 hours for repeated dosing

Elimination half-life 12–13 hours (single dose), 22 hours (repeated dosing)[2]

Does this mean, that if one takes Fluvoxamine once daily for example for 5 days, and then stops taking completely, it takes 22 hours for Fluvoxamine blood concentration to drop by 50% from peak value?

The PDF-source referenced by Wikipedia says:

"AUSTRALIAN PRODUCT INFORMATION LUVOX® Fluvoxamine maleate tablets DATE OF REVISION 11/01/2022

Maximum plasma levels occur within 3-8 hours of dosing. Steady state levels are usually achieved within one week. The mean plasma half-life is approximately 12-13 hours after a single dose and approximately 22 hours following repeated dosing. In vitro binding of fluvoxamine to human plasma proteins is 80%, and the volume of distribution is estimated to be 20 L/kg".

How can it take "one week" or was the 5 days just rounded up just in case? Could this explain it, from the same PDF:

"Metabolism The pharmacokinetics of fluvoxamine is linear between single oral doses of 25-100 mg. During multiple dosing in the range of 100-300 mg per day, the higher doses produced disproportionally higher plasma concentrations than predicted from data obtained with the lower dose".

--91.159.191.233 (talk) 22:56, 17 January 2022 (UTC)[reply]

Retrieved from "https://en.wikipedia.org/w/index.php?title=Talk:Fluvoxamine&oldid=1066341395"