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Fetzima

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

Medically reviewed by Jane Grigg, DipPharm. Last updated on Jan 8, 2020.

What is Fetzima?

Fetzima (levomilnacipran) is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SNRI). Levomilnacipran affects chemicals in the brain that may be unbalanced in people with depression.

Fetzima extended release capsules are used to treat major depressive disorder.

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

Important Information

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

Do not use Fetzima within 7 days before or 14 days after you have taken an MAO inhibitor, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Fetzima is not approved for use by anyone younger than 18 years old.

Before taking this medicine

You should not use Fetzima if you are allergic to levomilnacipran or milnacipran (Savella).

Do not use Fetzima within 7 days before or 14 days after you have taken an MAO inhibitor. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine.

To make sure Fetzima is safe for you, tell your doctor if you have ever had:

  • glaucoma;

  • heart problems, high blood pressure;

  • a stroke;

  • bleeding problems;

  • urination problems;

  • kidney disease;

  • a seizure;

  • low levels of sodium in your blood;

  • bipolar disorder (manic depression);

  • if there is a history of depression, manic behavior, or suicide in your family; or

  • if you drink alcohol.

Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. These medicines may interact with levomilnacipran and cause a serious condition called serotonin syndrome.

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

Ask your doctor about taking this medicine if you are pregnant. Taking an SNRI antidepressant during late pregnancy could increase your risk of excessive bleeding just after you give birth, and may cause serious medical complications in the baby. However, you may have a relapse of depression if you stop taking your antidepressant. Tell your doctor right away if you become pregnant. Do not start or stop taking this medicine without your doctor's advice.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of levomilnacipran on the baby.

If you breastfeed while taking Fetzima, tell your doctor if your baby is agitated or irritable and has feeding problems or trouble gaining weight.

Fetzima is not approved for use by anyone younger than 18 years old.

How should I take Fetzima?

Take Fetzima exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Take Fetzima at the same time each day, with or without food.

Swallow the Fetzima extended release capsule whole and do not crush, chew, break, or open it.

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

Do not stop using Fetzima 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.

Fetzima 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
Maintenance dose: 40 to 120 mg orally once a day
Maximum dose: 120 mg/day

Comments:
-The dose may be increased in increments of 40 mg at intervals of 2 or more days based on tolerability and efficacy.
-Efficacy was established in trials lasting 5 weeks.

Use: Treatment of Major Depressive Disorder (MDD)

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

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 Fetzima?

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

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

Fetzima side effects

Get emergency medical help if you have signs of an allergic reaction to Fetzima: 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, eye redness;

  • painful or difficult urination;

  • easy bruising, unusual bleeding, purple or red spots under your skin;

  • pounding heartbeats or fluttering in your chest;

  • seizure (convulsions);

  • manic episodes - racing thoughts, increased energy, decreased need for sleep, risk-taking behavior, being agitated or talkative; or

  • low sodium level - headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady.

Serious side effects may be more likely in older adults.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common Fetzima side effects may include:

  • nausea, vomiting, constipation;

  • irregular heartbeats;

  • sweating; 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.

What other drugs will affect Fetzima?

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as 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.

Using Fetzima with other drugs that make you drowsy can worsen this effect. Ask your doctor before using opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures.

Tell your doctor about all your other medicines, especially:

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 drug interactions are listed here.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Fetzima only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.