What is the most important information I should know about levomilnacipran?
Do not use levomilnacipran 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.
What is levomilnacipran?
Levomilnacipran is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SNRI).
Levomilnacipran is used to treat major depressive disorder.
A similar medicine called milnacipran (Savella) is used to treat a chronic pain disorder called fibromyalgia. Levomilnacipran (Fetzima) should not be used to treat fibromyalgia.
Levomilnacipran may also be used for purposes not listed in this medication guide.
What should I discuss with my healthcare provider before taking levomilnacipran?
You should not use this medicine if you are allergic to levomilnacipran or milnacipran (Savella).
Do not use levomilnacipran 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.
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 levomilnacipran, tell your doctor if your baby is agitated or irritable and has feeding problems or trouble gaining weight.
Levomilnacipran is not approved for use by anyone younger than 18 years old.
How should I take levomilnacipran?
Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.
Take the medicine at the same time each day, with or without food.
Swallow the 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 levomilnacipran 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.
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 levomilnacipran?
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.
What are the possible side effects of levomilnacipran?
Get emergency medical help if you have signs of an allergic reaction: 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 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 levomilnacipran?
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 levomilnacipran 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:
- 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.
This list is not complete. Other drugs may affect levomilnacipran, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Where can I get more information?
Your pharmacist can provide more information about levomilnacipran.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
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