Levomilnacipran Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Depression

Initial dose: 20 mg orally once a day for 2 days then increase to 40 mg orally once a day. Dose may be increased in increments of 40 mg at intervals of 2 or more days based on tolerability and efficacy.
Maintenance dose: 40 to 120 mg orally once a day
Maximum dose: 120 mg orally once a day

Approved indication: Major depressive disorder (MDD)

Renal Dose Adjustments

Mild (CrCl 60 to 89 mL/min): No adjustment recommended
Moderate (CrCl 30 to 59 mL/min): Dose adjustment recommended
Severe (CrCl 15 to 29 mL/min): Dose adjustment recommended
End stage renal disease: Not recommended

Liver Dose Adjustments

Mild (Child-Pugh 1 to 6): No adjustment recommended
Moderate (Child-Pugh 7 to 9): No adjustment recommended
Severe (Child-Pugh 10 to 13): No adjustment recommended

Dose Adjustments

Patients with moderate renal impairment (CrCl 30 to 59 mL/min): Maintenance dose should not exceed 80 mg orally once a day
Patients with severe renal impairment (CrCl 15 to 29 mL/min): Maintenance dose should not exceed 40 mg orally once a day

Gradual dose reduction is recommended whenever possible. If intolerable symptoms occur following a dose decrease or discontinuation of treatment, resuming the previous dose and decreasing the dose at a more gradual rate should be considered.

Dialysis

Data not available

Other Comments

Levomilnacipran may be administered without regard to meals.

Alcohol interacts with the extended-release properties of levomilnacipran. If levomilnacipran is taken with alcohol, a pronounced accelerated drug release may occur. Levomilnacipran should not be taken with alcohol.

At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of levomilnacipran and at least 7 days should be allowed after stopping levomilnacipran before starting an MAOI.

When a patient receiving levomilnacipran requires urgent treatment with linezolid or IV methylene blue and acceptable alternatives are not available and the potential benefits of linezolid or IV methylene blue treatment outweigh the risks of serotonin syndrome, levomilnacipran should be stopped, and linezolid or IV methylene blue can be administered. The patient should be monitored for symptoms of serotonin syndrome for 2 weeks or until 24 hours after the last dose of linezolid or IV methylene blue, whichever comes first. Levomilnacipran may be resumed 24 hours after the last dose of linezolid or IV methylene blue.

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