FLUXID

Clinical safety rating: caution

Comprehensive clinical and safety monograph for FLUXID (FLUXID).

How it works

FLUXID is a selective serotonin reuptake inhibitor (SSRI) that potentiates serotonergic activity by blocking the reuptake of serotonin at the presynaptic neuronal membrane, increasing serotonin availability in the synaptic cleft.

What the body does with it

Metabolism	Primarily metabolized by CYP2D6 and CYP2C19 isoenzymes to its active metabolite, norfluxid. Inhibits CYP2D6, leading to potential drug-drug interactions.
Excretion	Renal: 70% unchanged; Fecal: 20%; Biliary: 10%.
Half-life	Terminal half-life: 12 hours (range 10–14 hours). In renal impairment (CrCl <30 mL/min), half-life prolonged to 24–36 hours; dose adjustment required.
Protein binding	95% bound primarily to albumin; minor binding to alpha-1-acid glycoprotein.
Volume of Distribution	0.8 L/kg (range 0.6–1.0 L/kg), indicating distribution into total body water and moderate tissue binding.
Bioavailability	Oral: 85% (range 75–95%); no significant first-pass metabolism.
Onset of Action	Oral: 30–60 minutes; Intravenous: 5–10 minutes.
Duration of Action	Oral: 8–12 hours; Intravenous: 6–8 hours. Duration may be prolonged in hepatic impairment.

Classification & Brands

Dosing & administration

1-2 g IV every 8 hours; maximum 6 g/day.

Dosage form	TABLET, ORALLY DISINTEGRATING
Renal impairment	GFR >50 mL/min: no adjustment; GFR 10-50 mL/min: 1 g every 12 hours; GFR <10 mL/min: 1 g every 24 hours.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 25%; Child-Pugh C: reduce dose by 50% or consider alternative.
Pediatric use	50 mg/kg IV every 8 hours (max 2 g/dose) for children >1 month; adjust for renal function.
Geriatric use	Use with caution; monitor renal function; dose adjustment per CrCl.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for FLUXID (FLUXID).

Breastfeeding	FLUXID is excreted in breast milk with a milk-to-plasma ratio of 0.8. Due to potential for infant toxicity, breastfeeding is not recommended during therapy.
Teratogenic Risk	FLUXID is contraindicated in pregnancy. First trimester exposure is associated with a significant risk of major congenital malformations, particularly neural tube defects and cardiovascular anomalies. Second and third trimester exposure may cause fetal growth restriction, oligohydramnios, and neonatal nephrotoxicity.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants. Closely monitor for clinical worsening, suicidality, or unusual changes in behavior.

Side Effect Profile

Serious Effects

Absolute Contraindications

["Concurrent use of MAOIs (risk of serotonin syndrome)","Hypersensitivity to FLUXID or any excipient","Concurrent use of pimozide (risk of QT prolongation)","Concurrent use of thioridazine (risk of cardiac arrhythmias)","Use within 14 days of MAOI discontinuation (allow washout)"]

Clinical Precautions

Precautions

["Serotonin syndrome: risk with concurrent serotonergic drugs","Discontinuation syndrome: gradual taper recommended","Hyponatremia: particularly in elderly or volume-depleted patients","Increased bleeding risk: especially with NSAIDs or anticoagulants","Activation of mania/hypomania: screen for bipolar disorder before initiation","Angle-closure glaucoma: potential for mydriasis","Serotonin syndrome: potentially life-threatening condition requiring immediate discontinuation"]

Clinical Tips & Counseling

Drug interactions

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FLUXID

Clinical safety rating: caution

Comprehensive clinical and safety monograph for FLUXID (FLUXID).

How it works

What the body does with it

Metabolism	Primarily metabolized by CYP2D6 and CYP2C19 isoenzymes to its active metabolite, norfluxid. Inhibits CYP2D6, leading to potential drug-drug interactions.
Excretion	Renal: 70% unchanged; Fecal: 20%; Biliary: 10%.
Half-life	Terminal half-life: 12 hours (range 10–14 hours). In renal impairment (CrCl <30 mL/min), half-life prolonged to 24–36 hours; dose adjustment required.
Protein binding	95% bound primarily to albumin; minor binding to alpha-1-acid glycoprotein.
Volume of Distribution	0.8 L/kg (range 0.6–1.0 L/kg), indicating distribution into total body water and moderate tissue binding.
Bioavailability	Oral: 85% (range 75–95%); no significant first-pass metabolism.
Onset of Action	Oral: 30–60 minutes; Intravenous: 5–10 minutes.
Duration of Action	Oral: 8–12 hours; Intravenous: 6–8 hours. Duration may be prolonged in hepatic impairment.

Classification & Brands

Dosing & administration

1-2 g IV every 8 hours; maximum 6 g/day.

Dosage form	TABLET, ORALLY DISINTEGRATING
Renal impairment	GFR >50 mL/min: no adjustment; GFR 10-50 mL/min: 1 g every 12 hours; GFR <10 mL/min: 1 g every 24 hours.
Liver impairment	Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 25%; Child-Pugh C: reduce dose by 50% or consider alternative.
Pediatric use	50 mg/kg IV every 8 hours (max 2 g/dose) for children >1 month; adjust for renal function.
Geriatric use	Use with caution; monitor renal function; dose adjustment per CrCl.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for FLUXID (FLUXID).

Breastfeeding	FLUXID is excreted in breast milk with a milk-to-plasma ratio of 0.8. Due to potential for infant toxicity, breastfeeding is not recommended during therapy.
Teratogenic Risk	FLUXID is contraindicated in pregnancy. First trimester exposure is associated with a significant risk of major congenital malformations, particularly neural tube defects and cardiovascular anomalies. Second and third trimester exposure may cause fetal growth restriction, oligohydramnios, and neonatal nephrotoxicity.
Fetal Monitoring