Provider Briefing: Fluvoxamine XR Extended-Release Capsule Shortage

The ongoing shortage of Fluvoxamine Maleate Extended-Release Capsules continues to affect patients with OCD and social anxiety disorder nationwide. As a prescriber, you're likely hearing from patients who can't fill their prescriptions — and may be fielding questions about alternatives, formulation switches, and when supply will normalize.

This briefing provides a comprehensive overview of the shortage's timeline, its clinical implications, the current availability picture, and actionable steps you can take to support your patients.

Shortage Timeline

The key milestones of this shortage:

• February 2024: ASHP adds Fluvoxamine Maleate Extended-Release Capsules to the current shortage list. Both Par Pharmaceuticals and Teva Pharmaceuticals report supply constraints.
• Mid-2024: Becker's Hospital Review reports that "no solutions" are available, with both manufacturers citing manufacturing delays and supply chain disruptions.
• Late 2024 – 2025: Supply remains intermittent. Teva and Par each have periodic availability of 100 mg and 150 mg capsules, but consistent nationwide supply has not been restored.
• Early 2026: The shortage persists. No new manufacturers have entered the market, and no resolution timeline has been provided by either company.

The original brand product, Luvox CR, was discontinued years ago, eliminating any brand-name fallback.

Prescribing Implications

The limited availability of Fluvoxamine ER creates several clinical considerations:

Treatment Continuity Risk

Patients on stable Fluvoxamine XR regimens face treatment interruptions when pharmacies cannot fill prescriptions. Abrupt discontinuation of SSRIs can lead to discontinuation syndrome — including dizziness, nausea, paresthesias, irritability, insomnia, and rebound anxiety or OCD symptoms. Patients with OCD are particularly vulnerable, as symptom recurrence can occur rapidly without consistent medication.

CYP1A2 Inhibition Considerations

Fluvoxamine is the most potent CYP1A2 inhibitor among the SSRIs. Patients being switched to alternative SSRIs may see changes in the metabolism of concomitant medications metabolized by CYP1A2 (e.g., Theophylline, Clozapine, Olanzapine, caffeine). When transitioning patients off Fluvoxamine, review their full medication list for CYP1A2 substrates that may require dose adjustments.

Formulation Switch Logistics

Converting patients from extended-release to immediate-release Fluvoxamine is generally straightforward — the total daily dose remains the same, divided into two doses (typically morning and evening, or with the larger portion at bedtime). However, some patients report differences in tolerability between formulations, particularly GI side effects during the first 1-2 weeks.

Current Availability Picture

As of early 2026:

• Fluvoxamine ER capsules (100 mg, 150 mg): Limited and intermittent supply from Par Pharmaceuticals and Teva Pharmaceuticals. Stock varies by region and pharmacy.
• Fluvoxamine IR tablets (25 mg, 50 mg, 100 mg): Widely available with no reported shortage. Multiple manufacturers.
• Luvox CR (brand): Discontinued — not available.

Providers can direct patients to Medfinder for Providers to check real-time pharmacy stock of Fluvoxamine ER in their patients' areas.

Cost and Access Considerations

Cost remains a factor, particularly for uninsured or underinsured patients:

• Fluvoxamine ER cash price: $170–$440 per 30 capsules (strength-dependent)
• Fluvoxamine ER with coupons (GoodRx, SingleCare): $75–$107 per 30 capsules
• Fluvoxamine IR cash price with coupons: $16–$22 per 30 tablets
• Alternative SSRIs (Sertraline, Fluoxetine): $4–$15 per month with coupons

No manufacturer savings program exists for Fluvoxamine ER (brand discontinued). Patient assistance through NeedyMeds and RxAssist may help eligible patients access discounted or free medication.

Insurance coverage is generally intact — generic Fluvoxamine ER appears on most commercial and Medicare Part D formularies, typically at Tier 2 or Tier 3. Some plans may require prior authorization or step therapy (trying the IR formulation first).

Tools and Resources for Providers

Several resources can help you and your patients navigate the shortage:

• Medfinder for Providers: Real-time pharmacy stock checking tool. Share with patients or use during appointments to locate Fluvoxamine ER availability by zip code.
• ASHP Drug Shortage Database: Official shortage tracking with manufacturer updates.
• FDA Drug Shortage Database: Federal tracking of drug availability issues.
• NeedyMeds (needymeds.org): Directory of patient assistance programs for financially constrained patients.
• GoodRx / SingleCare: Coupon tools that can significantly reduce out-of-pocket costs for both ER and IR formulations.

Therapeutic Alternatives

When a switch is clinically appropriate, consider these alternatives based on the patient's primary indication:

For OCD

• Sertraline (Zoloft): FDA-approved for OCD. Typical dose 50–200 mg/day. Well-tolerated, fewer drug interactions than Fluvoxamine. Widely available, $4–$10/month.
• Fluoxetine (Prozac): FDA-approved for OCD. Typical dose 20–80 mg/day. Long half-life reduces discontinuation risk. $4–$8/month.
• Paroxetine (Paxil): FDA-approved for OCD. Typical dose 20–60 mg/day. CR formulation available. $10–$20/month.
• Clomipramine (Anafranil): TCA, FDA-approved for OCD. Reserve for SSRI-refractory cases. More side effects and monitoring required.

For Social Anxiety Disorder

• Sertraline: FDA-approved for SAD
• Paroxetine / Paroxetine CR: FDA-approved for SAD
• Venlafaxine XR (Effexor XR): SNRI, FDA-approved for SAD

Looking Ahead

With only two manufacturers in the market and no new entrants on the horizon, the Fluvoxamine ER shortage is likely to persist through at least mid-2026. Providers should proactively discuss contingency plans with patients currently on Fluvoxamine XR:

• Identify whether the IR formulation is an acceptable alternative
• Discuss SSRI alternatives in case of extended unavailability
• Ensure patients have a plan for what to do if they can't fill a prescription (e.g., contact the office rather than self-discontinue)
• Document the shortage-driven medication change in the patient's chart for continuity

Final Thoughts

The Fluvoxamine XR shortage is a concrete example of how thin the generic drug supply chain can be when a medication relies on only two manufacturers. While the clinical alternatives are well-established, the disruption to patient care is real — particularly for patients with OCD whose symptoms are well-controlled on Fluvoxamine.

By planning ahead, communicating proactively with patients, and utilizing real-time tools like Medfinder for Providers, you can help minimize the impact of this shortage on your patient population.

For patient-facing resources you can share, see our patient shortage update and guide to finding Fluvoxamine XR in stock.