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

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
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Aprepitant, Fosaprepitant
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Articaine; Epinephrine
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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
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Carbinoxamine; Hydrocodone; Pseudoephedrine
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Chlordiazepoxide; Clidinium
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Chlorpheniramine; Dextromethorphan; Phenylephrine
Chlorpheniramine; Dihydrocodeine; Phenylephrine
Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
Chlorpheniramine; Hydrocodone
Chlorpheniramine; Hydrocodone; Phenylephrine
Chlorpheniramine; Hydrocodone; Pseudoephedrine
Chlorthalidone; Clonidine
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Dextromethorphan; Guaifenesin
Dextromethorphan; Guaifenesin; Phenylephrine
Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
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Dextromethorphan; Promethazine
Dextromethorphan; Quinidine
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Hydrocodone; Pseudoephedrine
Hydromorphone
Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
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Ibuprofen; Oxycodone
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Ambrisentan

Can nitroglycerin used to dilate the coronary arteries and obtain better images

Partial Hip Replacement

Cross Eyes