Give a short and critical explanation of the rationale of using fluvoxamine (a selective serotonin reuptake inhibitor (SSRI) in the treatment of Covid patients. Your answer must be properly and appropriately referenced (in-text references as well).

According to National Institutes of Health (NIH, 2021) fluvoxamine is a selective serotonin reuptake inhibitor (SSRI). It is approved by the  Food and Drug Administration (FDA) for the treatment of obsessive-compulsive disorder. It is also used in depression and other conditions.

The studies that have been done, show that fluvoxamine was found to bind to the sigma-1 receptor in immune cells, resulting in reduced production of inflammatory cytokines. It also reduces the expression of inflammatory genes in an invitro study of human endothelial cells and macrophages.

In the Medical letter (Medical letter, 2021:63) it is written that sigma-1 agonism has been shown to inhibit SARS-CoV-2 replication and to modulate the inflammatory response to sepsis. It could theoretically prevent development of life-threatening cytokine storm and acute respiratory distress syndrome in COVID-19.

 According to the article from K. Hashimoto (NIH ,2021) 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.

Reference list:

NIH (National institute of health). 2021. https://www.covid19treatmentguidelines.nih.gov/therapies/immunomodulators/fluvoxamine/ Date of access: 13 Oct. 2021

NIH (National institute of health). 2021. https://pubmed.ncbi.nlm.nih.gov/33403480/ Date of access: 13 Oct. 2021

Medical letter. 2021.https://secure.medicalletter.org/sites/default/files/freedocs/w1623d.pdf Date op access: 13 Oct. 2021