Mechanism of Action: The exact mechanism of the antidepressant action of levomilnacipran is unknown but is thought to be related to the potentiation of serotonin and norepinephrine in the central nervous system through inhibition of reuptake at serotonin and norepinephrine transporters. –Drug Bank
Indication: Major Depression Disorder
Dosing: The typical starting dose is 20 mg by mouth once a day for 2 days. Then, your dose will be raised to 40 mg by mouth once a day. Your provider will adjust your dose based on how you respond to the medication. The maximum dose is 120 mg per day. If you have kidney problems, the maximum dose is 40 or 80 mg per day, depending on the severity of your kidney condition. Ask your provider what the maximum amount of Fetzima (levomilnacipran) you can take. –Good Rx
Pros
- Only taken once a day
- Doesn’t cause changes in your weight compared to other similar medications
- Works on two chemicals in the brain to help with depression
Cons
- Can raise your heartbeat and blood pressure
- Can cause erectile dysfunction in males
- Cannot help with chronic pain or anxiety, unlike similar medications in this class
- No generic is available, so it can be expensive
Some (not all) Interactions: any other antidepressant; sibutramine; St. John’s wort; tryptophan (sometimes called L-tryptophan); a diuretic or “water pill”; a blood thinner (warfarin, Coumadin, Jantoven); diet pills, stimulants, or medicine to treat attention deficit hyperactivity disorder (ADHD) such as Adderall or Ritalin; pain medication–fentanyl, tramadol; medicine to treat anxiety, mood disorders, thought disorders, or mental illness–buspirone, lithium, and many others; or migraine headache medicine–sumatriptan, rizatriptan, zolmitriptan, and others. –Drugs.com
Food Interactions (-DrugBank):
- Avoid alcohol. Ingesting alcohol may compromise the extended-release dosage form of levomilnacipran, causing an accelerated release of the drug, increasing its serum concentration.
- Avoid herbs and supplements with anticoagulant/antiplatelet activity. Taking herbs with antiplatelet or anticoagulant activity may increase the risk of bleeding. Examples include garlic, ginger, bilberry, danshen, piracetam, and ginkgo biloba.
- Exercise caution with grapefruit products. Grapefruit is a moderate to strong CYP3A4 inhibitor. Do not exceed a maximum levomilnacipran dose of 80mg daily when taking strong CYP3A4 inhibitors.
- Exercise caution with St. John’s Wort. Administering levomilnacipran with St. John’s Wort may increase the risk of serotonin syndrome.
- Take with or without food.
Additional Information
Official Medication Website: Fetzima (levomilnacipran)
- FDA Approves Medication for Major Depressive Disorder –Psychiatric News
- Levomilnacipran is believed to be the more active enantiomer of milnacipran, which has been available in Europe for years and was approved by the FDA in 2009 for treating fibromyalgia. –MD Edge (graphic below)
