levomilnacipran

Generic Name: levomilnacipran (LEE voe mil NA si pran)
Brand Name: Fetzima

What is levomilnacipran?

Levomilnacipran is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SNRI). Levomilnacipran affects chemicals in the brain that may become unbalanced and cause depression.

Levomilnacipran is used to treat major depressive disorder.

A similar medicine called milnacipran (Savella) is used to treat a chronic pain disorder called fibromyalgia. Levomilnacipran (Fetzima) should not be used to treat fibromyalgia.

Levomilnacipran may also be used for purposes not listed in this medication guide.

What is the most important information I should know about levomilnacipran?

You should not use levomilnacipran if you have untreated or uncontrolled narrow-angle glaucoma.

Do not use levomilnacipran if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine. Do not use an MAO inhibitor within 7 days after you stop taking levomilnacipran.

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Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using levomilnacipran. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Do not give this medicine to anyone younger than 18 years old without the advice of a doctor. Levomilnacipran is not approved for use in children.

What should I discuss with my healthcare provider before taking levomilnacipran?

Do not use levomilnacipran if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine. Do not use an MAO inhibitor within 7 days after you stop taking levomilnacipran.

You should not use this medicine if you are allergic to levomilnacipran or milnacipran (Savella), or if you have untreated or uncontrolled narrow-angle glaucoma.

To make sure levomilnacipran is safe for you, tell your doctor if you have:

  • heart disease, high blood pressure, heart rhythm disorder;

  • a bleeding or blood clotting disorder such as hemophilia;

  • bipolar disorder (manic depression);

  • narrow-angle glaucoma;

  • seizures or epilepsy;

  • kidney disease;

  • low levels of sodium in your blood;

  • bladder obstruction or other urination problems;

  • if you drink large amounts of alcohol; or

  • if you take a diuretic ("water pill") or use migraine headache medicine.

Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using levomilnacipran. Your family or other caregivers should also be alert to changes in your mood or symptoms.

FDA pregnancy category C. It is not known whether levomilnacipran will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

It is not known whether levomilnacipran passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.

Do not give this medicine to anyone younger than 18 years old without the advice of a doctor. Levomilnacipran is not approved for use in children.

How should I take levomilnacipran?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You may take levomilnacipran with or without food.

Do not crush, chew, break, or open a levomilnacipran capsule. Swallow it whole.

Your blood pressure and heart rate will need to be checked often.

Do not stop using levomilnacipran suddenly, or you could have unpleasant withdrawal symptoms. Follow your doctor's instructions about tapering your dose.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking levomilnacipran?

Avoid drinking alcohol. It may raise your blood levels of levomilnacipran.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with levomilnacipran may cause you to bruise or bleed easily.

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Levomilnacipran side effects

Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;

  • painful or difficult urination;

  • seizure (convulsions);

  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

  • pounding heartbeats or fluttering in your chest;

  • high levels of serotonin in the body--agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting; or

  • low levels of sodium in the body--headache, confusion, slurred speech, severe weakness, muscle cramps, loss of coordination, feeling unsteady, fainting, shallow breathing.

Older adults may be more sensitive to the side effects of this medication.

Common side effects may include:

  • nausea, vomiting, constipation;

  • vision changes;

  • increased sweating;

  • fast heart rate; or

  • decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Levomilnacipran dosing 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)

What other drugs will affect levomilnacipran?

Taking this medicine with other drugs that make you sleepy or slow your breathing can worsen these effects. Ask your doctor before taking levomilnacipran with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with levomilnacipran, especially:

  • any other antidepressant;

  • sibutramine;

  • tramadol;

  • St. John's wort;

  • tryptophan (sometimes called L-tryptophan);

  • a diuretic or "water pill";

  • a blood thinner (warfarin, Coumadin, Jantoven);

  • medicine to treat mood disorders, thought disorders, or mental illness--buspirone, lithium, and many others; or

  • migraine headache medicine--sumatriptan, rizatriptan, zolmitriptan, and others.

This list is not complete. Other drugs may interact with levomilnacipran, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Where can I get more information?

  • Your pharmacist can provide more information about levomilnacipran.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 1.02. Revision Date: 2014-08-23, 9:06:12 AM.

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