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
- abdominal pain
- agitation
- angina
- anorexia
- bleeding
- blurred vision
- cardiomyopathy
- chest pain (unspecified)
- constipation
- depression
- dizziness
- dyskinesia
- dysuria
- ecchymosis
- ejaculation dysfunction
- elevated hepatic enzymes
- epistaxis
- erythema multiforme
- flatulence
- GI bleeding
- hematoma
- hematuria
- hostility
- hot flashes
- hyperhidrosis
- hypertension
- hyponatremia
- hypotension
- impotence (erectile dysfunction)
- increased urinary frequency
- maculopapular rash
- mania
- migraine
- mydriasis
- nausea
- neonatal abstinence syndrome
- ocular hemorrhage
- orthostatic hypotension
- palpitations
- paresthesias
- petechiae
- platelet dysfunction
- polydipsia
- proteinuria
- pruritus
- rash
- seizures
- serotonin syndrome
- SIADH
- sinus tachycardia
- Stevens-Johnson syndrome
- suicidal ideation
- syncope
- teeth grinding (bruxism)
- testicular pain
- toxic epidermal necrolysis
- urinary retention
- urticaria
- vomiting
- withdrawal
- xerophthalmia
- xerosis
- 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
