Escitalopram and fluvoxamine combination therapy in a patient with treatment-resistant obsessive-compulsive disorder: a case report

Seiichiro Tarutani; Hiroki Kikuyama; Yumi Tamura; Tatsushi Okayama; Katsunori Toyoda; Tetsufumi Kanazawa; Munehiro Ohta; Norio Yasui-Furukori; Takehiko Okamura; Hiroshi Yoneda

doi:10.5234/cnpt.7.36

Case Report

Escitalopram and fluvoxamine combination therapy in a patient with treatment-resistant obsessive-compulsive disorder: a case report

Seiichiro Tarutani, Hiroki Kikuyama, Yumi Tamura, Tatsushi Okayama, Katsunori Toyoda, Tetsufumi Kanazawa, Munehiro Ohta, Norio Yasui-Furukori, Takehiko Okamura, Hiroshi Yoneda

Author information

Seiichiro Tarutani
Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry
Department of Neuropsychiatry, Osaka Medical College
Hiroki Kikuyama
Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry
Department of Neuropsychiatry, Osaka Medical College
Yumi Tamura
Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry
Tatsushi Okayama
Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry
Department of Neuropsychiatry, Osaka Medical College
Katsunori Toyoda
Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry
Department of Neuropsychiatry, Osaka Medical College
Tetsufumi Kanazawa
Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry
Department of Neuropsychiatry, Osaka Medical College
Munehiro Ohta
Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry
Norio Yasui-Furukori
Department of Neuropsychiatry, Hirosaki University School of Medicine
Takehiko Okamura
Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry
Hiroshi Yoneda
Department of Psychiatry, Shin-Abuyama Hospital, Osaka Institute of Clinical Psychiatry
Department of Neuropsychiatry, Osaka Medical College

Keywords: obsessive-compulsive disorder (OCD), combination therapy, escitalopram, fluvoxamine, drug interaction, CYP2C19

JOURNAL FREE ACCESS

2016 Volume 7 Pages 36-40

DOI https://doi.org/10.5234/cnpt.7.36

Details

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are useful for the treatment of obsessive-compulsive disorder (OCD). Although combination therapies are recommended for treatment-resistant OCD, combination therapies involving the use of two SSRIs are not recommended. Here we report the case of a Japanese female who experienced improvement from combination therapy with escitalopram (ESC) and fluvoxamine (FLV). This patient had previously stopped taking other antidepressants because of tolerability issues. Since ESC had been partially effective, she refused to stop taking ESC. We therefore augmented her ESC therapy with FLV 25 mg/day, which resulted in inhibition of the metabolism of ESC by cytochrome P450 2C19 (CYP2C19). After this augmentation, the patient experienced a remarkable improvement in social functioning. The patient had a CYP2C19*1/*1 polymorphism. The patient's serum levels of ESC in the use of ESC plus FLV combination therapy and in the use of ESC alone were 67.7 ng/mL and 36.0 ng/mL, respectively. ESC and FLV combination therapy may be effective provided patients' CYP2C19 polymorphisms are checked and their serum concentrations of ESC are monitored.

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