A review of published medical studies on fluvoxamine for treating COVID-19.

Key Messages

This article reviews the use of fluvoxamine to treat COVID-19 that is available in the published medical literature.

The role of activation of the Sigma-1 receptor in reducing the severity of COVID-19 is reviewed.

The effect of fluvoxamine on activating the Sigma-1 receptor is reviewed and discussed.

Some of the important advantages of fluvoxamine including its well-established safety profile, low cost, and suitability as an oral medication are discussed.

European Archives of Psychiatry and Clinical Neuroscience

Publication Date: January 5, 2021
Peer Reviewed: No
Publication Type: Review/Commentary/Letter
DOI: https://www.doi.org/10.1007/s00406-020-01231-x

Repurposing of CNS drugs to treat COVID-19 infection: targeting the sigma-1 receptor

Kenji Hashimoto


The novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The escalating number of SARS-CoV-2-infected individuals has conferred the viral spread with the status of global pandemic. However, there are no prophylactic or therapeutic drugs available on the market to treat COVID-19, although several drugs have been approved. Recently, two articles using the comparative viral-human protein–protein interaction map revealed that the sigma-1 receptor in the endoplasmic reticulum plays an important role in SARS-CoV-2 replication in cells. Knockout and knockdown of SIGMAR1 (sigma-1 receptor, encoded by SIGMAR1) caused robust reductions in SARS-CoV-2 replication, which indicates that the sigma-1 receptor is a key therapeutic target for SARS-CoV-2 replication. Interestingly, a recent clinical trial demonstrated that treatment with the antidepressant fluvoxamine, which has a high affinity at the sigma-1 receptor, could prevent clinical deterioration in adult outpatients infected with SARS-CoV-2. In this review, we discuss the brief history of the sigma-1 receptor and its role in SARS-CoV-2 replication in cells. Here, we propose repurposing of traditional central nervous system (CNS) drugs that have a high affinity at the sigma-1 receptor (i.e., fluvoxamine, donepezil, ifenprodil) for the treatment of SARS-CoV-2-infected patients. Finally, we discussed the potential of other CNS candidates such as cutamesine and arketamine.