Does Fluvoxamine cause gynecomastia? (3+ factors)
In this article, we will answer the question “Does Fluvoxamine cause gynecomastia?”. We will also discuss research findings of antidepressant-induced gynecomastia and what other factors can contribute to this issue.
Does Fluvoxamine cause gynecomastia?
Fluvoxamine (also known as Luvox) does have the potential to cause gynecomastia in men. Fluvoxamine, an antidepressant belonging to the class of selective serotonin reuptake inhibitors (SSRIs), is approved by the FDA for the treatment of obsessive-compulsive disorder (OCD) (1). It has many ‘off-label uses’ in other depressive illnesses.
Gynecomastia is the enlargement of the breasts in men or boys. The breasts become large and sometimes may even grow unevenly. If there is an imbalance between estrogen and androgen hormones in men, gynecomastia may occur. Gynecomastia may be caused by various issues like hormonal changes, medicines, recreational drug use and tumours.
What is the link between Fluvoxamine and gynecomastia?
Antidepressants, particularly SSRIs are known to cause gynecomastia. This is often an overlooked side effect of antidepressant therapy. The increased levels of serotonin in the brain by Fluvoxamine and other SSRIs are the cause of gynecomastia.
Fluvoxamine and all other SSRIs work by increasing the level of serotonin in the brain. Serotonin increases the secretion of prolactin and weakens the inhibition of this hormone by dopamine. This causes even more increased levels of prolactin resulting in hyperprolactinemia. These elevated prolactin levels decrease androgen and increase estrogen and progesterone leading to gynecomastia (2,3).
What does research suggest?
Research findings show gynecomastia as a side effect of antidepressant therapy. Many studies have reported this adverse event to be caused in individuals receiving therapy for various depressive illnesses.
A case study assessing the effects of antidepressants on the occurrence of gynecomastia in an elderly male reported that altered dopamine and sexual hormone levels due to SSRIs are responsible for the occurrence of this side effect in the patient (3).
Another case study reported the occurrence of bilateral gynecomastia and galactorrhea in a 19-year-old male who was being treated for OCD with Fluvoxamine and risperidone. These side effects led to a change in prescription (4).
Another clinical study reported that Fluvoxamine can cause an increase in serum prolactin levels. The study reported that prolactin levels of individuals receiving therapy were checked before treatment with Fluvoxamine, and were found to be normal. So Fluvoxamine can indirectly affect prolactin-related mechanisms (5).
Fluvoxamine and other SSRIs like Lexapro are known to cause alterations in prolactin levels, which can lead to various hormonal issues in individuals taking therapy.
What other factors contribute to gynecomastia?
Gynecomastia can be caused by many other factors. Some of these are as follows (6):
A hormonal imbalance between estrogen and testosterone can be associated with the occurrence of gynecomastia. This imbalance can occur naturally like in newborns due to the effects of maternal estrogen.
Sometimes hormonal imbalance can also occur in puberty causing gynecomastia, which tends to go away after the changes in hormones go back to normal. Adults can also experience this effect due to a decrease in testosterone levels.
Medicines such as antidepressants, steroids, opioids, estrogens and chemotherapeutic agents can contribute to this condition and can cause the occurrence of gynecomastia in patients receiving therapy with these agents.
Sometimes underlying medical conditions like breast cancer, tumours, obesity, adrenal disease, hypogonadism, thyroid disease, malnutrition and liver or kidney failure can also contribute to this condition.
Alcohol and drug abuse
Alcohol and recreational drugs like marijuana, amphetamines or heroin can also cause gynecomastia in men who are addicted to any of these substances.
How to manage Fluvoxamine-induced gynecomastia?
If you experience Fluvoxamine-induced gynecomastia, make sure to talk to your doctor about your condition. Your doctor will assess the benefits and risks of Fluvoxamine treatment and will suggest an appropriate plan. You may need a change in dosage or an alternative medication in place of Fluvoxamine.
If you experience symptoms like pain, tenderness, swelling or feel a hard mass within your breast you should talk to your healthcare provider immediately. Gynecomastia may be caused by some underlying medical condition that needs to be addressed.
There is not much you can do to manage Fluvoxamine-induced gynecomastia. You can by most avoid alcohol and substance abuse to decrease your risk of experiencing this side effect. Medications like tamoxifen, clomiphene and danazol do have a positive response in treating gynecomastia but also have an array of side effects so they are not well-tolerated.
To the best of my knowledge and according to research findings Fluvoxamine can cause gynecomastia in individuals receiving this medication. Although, this condition does not have many physical complexities but can affect the mental health of individuals because they are concerned about the way their breast looks. The only way to treat this condition is to get rid of the causative agent.
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The Food and Drug Administration (FDA). HIGHLIGHTS OF PRESCRIBING INFORMATION. LUVOX® (fluvoxamine maleate) Tablets for oral administration. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/022235lbl.pdf
Bembo SA, Carlson HE. Gynecomastia: its features, and when and how to treat it. Cleveland Clinic Journal of Medicine. 2004 Jun 1;71(6):511-7. https://www.ccjm.org/content/ccjom/71/6/511.full.pdf
Kaufman KR, Podolsky D, Greenman D, Madraswala R. Antidepressant-selective gynecomastia. Annals of Pharmacotherapy. 2013 Jan;47(1):e6-. https://pubmed.ncbi.nlm.nih.gov/23324513/
Pratheesh PJ, Praharaj SK, Srivastava A. Euprolactinemic gynecomastia and galactorrhea with risperidone-fluvoxamine combination. Psychopharmacology Bulletin. 2011 Feb 2;44(1):70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044559/
Spigset O, Mjorndal T. The Effect of Fluvoxamine on Serum Prolactin and Serum Sodium Concentrations: Relation to Platelet 5-HT: 2A: Receptor Status. Journal of clinical psychopharmacology. 1997 Aug 1;17(4):292-7. https://journals.lww.com/psychopharmacology/abstract/1997/08000/the_effect_of_fluvoxamine_on_serum_prolactin_and.9.aspx
Vandeven HA, Pensler JM. Gynecomastia. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430812/