Levomilnacipran

Levomilnacipran Brand Name– FETZIMA

What is Levomilnacipran

Levomilnacipran is a serotonin norepinephrine reuptake inhibitor (SNRI) used for the treatment of major depressive disorder in adults.

SNRIs are not approved in pediatric patients with depression; however, the American Academy of Child and Adolescent Psychiatry (AACAP) guidelines recommend antidepressants when nonpharmacologic treatment is insufficient or illness severity is high.

Due to limited data in treating pediatric depression, SNRIs are generally reserved for pediatric patients with documented antidepressant treatment failure or intolerability to a selective serotonin reuptake inhibitor (SSRI).

Levomilnacipran is an enantiomer of milnacipran, an SNRI indicated for the treatment of fibromyalgia.

Unlike milnacipran, the safety and efficacy of levomilnacipran in the management of fibromyalgia have not been established. Similar to other SNRIs, levomilnacipran has been associated with increases in blood pressure and heart rate; therefore, caution is recommended in patients with hypertension or other conditions that may be adversely affected by increased blood pressure or heart rate.

Product labels for all antidepressants contain a boxed warning related to an increased risk of suicidality in children, adolescents, and young adults during the initial stages of therapy when treating depression or other conditions; therefore, the necessity of pharmacologic therapy versus the potential risks should be carefully considered in these populations.

Indications

  • depression

For the treatment of major depression

Side Effects

  1. abdominal pain
  2. agitation
  3. angina
  4. anorexia
  5. bleeding
  6. blurred vision
  7. cardiomyopathy
  8. chest pain (unspecified)
  9. constipation
  10. depression
  11. dizziness
  12. dyskinesia
  13. dysuria
  14. ecchymosis
  15. ejaculation dysfunction
  16. elevated hepatic enzymes
  17. epistaxis
  18. erythema multiforme
  19. flatulence
  20. GI bleeding
  21. hematoma
  22. hematuria
  23. hostility
  24. hot flashes
  25. hyperhidrosis
  26. hypertension
  27. hyponatremia
  28. hypotension
  29. impotence (erectile dysfunction)
  30. increased urinary frequency
  31. maculopapular rash
  32. mania
  33. migraine
  34. mydriasis
  35. nausea
  36. neonatal abstinence syndrome
  37. ocular hemorrhage
  38. orthostatic hypotension
  39. palpitations
  40. paresthesias
  41. petechiae
  42. platelet dysfunction
  43. polydipsia
  44. proteinuria
  45. pruritus
  46. rash
  47. seizures
  48. serotonin syndrome
  49. SIADH
  50. sinus tachycardia
  51. Stevens-Johnson syndrome
  52. suicidal ideation
  53. syncope
  54. teeth grinding (bruxism)
  55. testicular pain
  56. toxic epidermal necrolysis
  57. urinary retention
  58. urticaria
  59. vomiting
  60. withdrawal
  61. xerophthalmia
  62. xerosis
  63. yawning

Monitoring Parameters

  • blood pressure
  • heart rate

Contraindications

  • abrupt discontinuation
  • anticoagulant therapy
  • bipolar disorder
  • bleeding
  • breast-feeding
  • cardiac arrhythmias
  • cardiac disease
  • cerebrovascular disease
  • children
  • closed-angle glaucoma
  • coronary artery disease
  • dehydration
  • dialysis
  • driving or operating machinery
  • eclampsia
  • ethanol ingestion
  • geriatric
  • hypertension
  • hyponatremia
  • hypotension
  • hypovolemia
  • increased intraocular pressure
  • infants
  • mania
  • MAOI therapy
  • milnacipran hypersensitivity
  • myocardial infarction
  • neonates
  • obstetric delivery
  • pregnancy
  • renal failure
  • renal impairment
  • seizure disorder
  • seizures
  • substance abuse
  • suicidal ideation
  • tachycardia
  • thrombolytic therapy
  • urinary retention
  • urinary tract obstruction

Interactions

  • Abciximab
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Tramadol
  • Alfentanil
  • Almotriptan
  • Alprazolam
  • Alteplase
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine; Celecoxib
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amphetamine; Dextroamphetamine Salts
  • Amprenavir
  • Anagrelide
  • Antithrombin III
  • Apixaban
  • Aprepitant, Fosaprepitant
  • Argatroban
  • Articaine; Epinephrine
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Atazanavir; Cobicistat
  • Atomoxetine
  • Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzhydrocodone; Acetaminophen
  • Benzodiazepines
  • Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
  • Benzphetamine
  • Betrixaban
  • Bismuth Subsalicylate
  • Bismuth Subsalicylate; Metronidazole; Tetracycline
  • Bivalirudin
  • Boceprevir
  • Brompheniramine; Dextromethorphan; Guaifenesin
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Buprenorphine
  • Buprenorphine; Naloxone
  • Buspirone
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Celecoxib
  • Ceritinib
  • Chloramphenicol
  • Chlordiazepoxide
  • Chlordiazepoxide; Clidinium
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dextromethorphan
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorthalidone; Clonidine
  • Choline Salicylate; Magnesium Salicylate
  • Cilostazol
  • Citalopram
  • Clarithromycin
  • Clomipramine
  • Clonazepam
  • Clonidine
  • Clopidogrel
  • Clorazepate
  • Cobicistat
  • Cocaine
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Conivaptan
  • Cyclobenzaprine
  • Dabigatran
  • Dalteparin
  • Danaparoid
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Desipramine
  • Desirudin
  • Desvenlafaxine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmethylphenidate
  • Dextromethorphan
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Promethazine
  • Dextromethorphan; Quinidine
  • Diazepam
  • Diclofenac
  • Diclofenac; Misoprostol
  • Diflunisal
  • Digoxin
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Dipyridamole
  • Diuretics
  • Dolasetron
  • Doxepin
  • Duloxetine
  • Edoxaban
  • Elbasvir; Grazoprevir
  • Eletriptan
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Enoxaparin
  • Epinephrine
  • Eptifibatide
  • Ergot alkaloids
  • Escitalopram
  • Esomeprazole; Naproxen
  • Estazolam
  • Ethanol
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenfluramine
  • Fenoprofen
  • Fentanyl
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Flurazepam
  • Flurbiprofen
  • Fluvoxamine
  • Fondaparinux
  • Fosamprenavir
  • Frovatriptan
  • Granisetron
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Heparin
  • Homatropine; Hydrocodone
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Imipramine
  • Indinavir
  • Indomethacin
  • Iobenguane I 131
  • Isavuconazonium
  • Isoniazid, INH
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Itraconazole
  • Ketoconazole
  • Ketoprofen
  • Ketorolac
  • Lansoprazole; Naproxen
  • Lasmiditan
  • Lepirudin
  • Lesinurad
  • Lesinurad; Allopurinol
  • Letermovir
  • Levorphanol
  • Linezolid
  • Lisdexamfetamine
  • Lithium
  • Lopinavir; Ritonavir
  • Lorazepam
  • Lorcaserin
  • Magnesium Salicylate
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Meperidine
  • Meperidine; Promethazine
  • Methadone
  • Methamphetamine
  • Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
  • Methylene Blue
  • Methylphenidate
  • Midazolam
  • Milnacipran
  • Mirtazapine
  • Monoamine oxidase inhibitors
  • Morphine
  • Morphine; Naltrexone
  • Nabumetone
  • Nalbuphine
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Naratriptan
  • Nefazodone
  • Netupitant, Fosnetupitant; Palonosetron
  • Nonsteroidal antiinflammatory drugs
  • Norepinephrine
  • Nortriptyline
  • Ombitasvir; Paritaprevir; Ritonavir
  • Ondansetron
  • Oxaprozin
  • Oxazepam
  • Oxycodone
  • Oxymorphone
  • Ozanimod
  • Palonosetron
  • Paroxetine
  • Pentazocine
  • Pentazocine; Naloxone
  • Pentosan
  • Perphenazine; Amitriptyline
  • Phentermine
  • Phentermine; Topiramate
  • Piroxicam
  • Platelet Inhibitors
  • Posaconazole
  • Prasugrel
  • Prilocaine; Epinephrine
  • Procarbazine
  • Protriptyline
  • Quazepam
  • Rasagiline
  • Remifentanil
  • Reteplase, r-PA
  • Ribociclib
  • Ribociclib; Letrozole
  • Ritonavir
  • Rivaroxaban
  • Rizatriptan
  • Rofecoxib
  • Safinamide
  • Salicylates
  • Salsalate
  • Selective serotonin reuptake inhibitors
  • Selegiline
  • Serotonin-Receptor Agonists
  • Sertraline
  • Sibutramine
  • Solriamfetol
  • St. John’s Wort, Hypericum perforatum
  • Streptokinase
  • Sufentanil
  • Sulindac
  • Sumatriptan
  • Tapentadol
  • Tedizolid
  • Telaprevir
  • Telithromycin
  • Telotristat Ethyl
  • Temazepam
  • Tenecteplase
  • Thrombolytic Agents
  • Ticagrelor
  • Ticlopidine
  • Tinzaparin
  • Tipranavir
  • Tirofiban
  • Tolmetin
  • Tramadol
  • Trazodone
  • Triazolam
  • Tricyclic antidepressants
  • Trimipramine
  • Tucatinib
  • Urokinase
  • Valdecoxib
  • Venlafaxine
  • Vilazodone
  • Vorapaxar
  • Voriconazole
  • Vortioxetine
  • Warfarin
  • Zolmitriptan
  • Zolpidem
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