Is it possible to use fluvoxamine to improve the tolerability or metabolic side effects of clozapine?

Some researchers have had success using fluvoxamine to improve the metabolic side effects of clozapine by increasing blood levels of clozapine. However, other studies have not found this to be helpful. This is a somewhat risky and unpredictable strategy, since fluvoxamine can raise clozapine levels 5 to 10 fold, and P450 enzyme interaction effects are not predictable or consistent. This strategy includes frequently checking blood levels. While there could be patients for whom providers consider this strategy, it is not commonly used. Other approaches to metabolic and weight management are often preferable.

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