Fetzima
Fetzima, the brand name for levomilnacipran, is used to treat depression in adults. This antidepressant belongs to the drug class called serotonin and norepinephrine reuptake inhibitors (SNRIs). It comes as an extended-release capsule that you take by mouth once a day. You can take this medication at any time of the day, but make sure you take it about the same time each day. Side effects include nausea, constipation, and sweating.
What is Fetzima (levomilnacipran)?
What is Fetzima (levomilnacipran) used for?
Depression in adults
How Fetzima (levomilnacipran) works
Fetzima (levomilnacipran) is a serotonin and norepinephrine reuptake inhibitor (SNRI). It works by raising the amount of serotonin and norepinephrine in the brain. These chemicals play a role in regulating mood.
Drug Facts
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What are the side effects of Fetzima (levomilnacipran)?
Common Side Effects
- Nausea (17%)
- Constipation (9%)
- Sweating (9%)
- Fast heart rate (6%)
- Erectile dysfunction (6%)
- Vomiting (5%)
Other Side Effects
- Stomach pain
- Gas
- Lower appetite
- Migraine
- Numbness or tingling
- Dry eye
- Dry skin
- Itching
- Rash
- Hot flash
- Problems with urination (e.g., trouble urinating)
- Changes in behavior
- Higher blood pressure
Serious Side Effects
- Suicidal thoughts or behaviors
- Serotonin syndrome: fever, sweating, movement problems, distress, hallucinations
- Bleeding or bruising: unusual bleeding or bruising, bleeding or bruising that doesn't go away, nosebleeds, blood in your urine or stool
- Low sodium levels: headache, trouble concentrating, memory problems, confusion, weakness, unsteadiness, hallucinations, fainting
- Seizure
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Difficult urination
fast, pounding, or irregular heartbeat or pulse
Less common
arm, back, or jaw pain
blurred vision
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
chest pain or discomfort
chest tightness or heaviness
cloudy urine
confusion
decrease in the frequency of urination
difficulty in passing urine (dribbling)
difficulty with speaking
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fainting
headache
irritability
loss of balance control
muscle trembling, jerking, or stiffness
pounding in the ears
rapid or irregular heartbeat
restlessness
shaking
shuffling walk
slow heartbeat
stiffness of the limbs
sweating
trouble breathing
trouble sleeping
twisting movements of the body
uncontrolled movements, especially of the face, neck, and back
unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Difficulty having a bowel movement (stool)
increased sweating
loss in sexual ability, desire, drive, or performance
vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Fetzima (levomilnacipran)
Cons
Can make your heart race and raise your blood pressure
Can cause sexual side effects (e.g., low sex drive, erectile dysfunction)
Can have uncomfortable side effects if you stop the medication too suddenly
Pharmacist tips for Fetzima (levomilnacipran)
You can take Fetzima (levomilnacipran) at any time of day that's convenient for you. Be sure to try to stick with around the same time each day. This helps make it part of your daily routine to help you remember to take your medication.
Swallow Fetzima (levomilnacipran) capsules whole. Don't open, crush, or chew the capsules. If you have trouble swallowing it whole, let your prescriber know. They might switch you to a different antidepressant that might be easier for you to take.
You can take Fetzima (levomilnacipran) with or without food. Taking it with food might help lessen stomach upset and nausea, which are common side effects.
Nausea and constipation are common side effects of Fetzima (levomilnacipran). Eating smaller meals can help with nausea. Drink plenty of water and eat more fiber to ease constipation. Tell your care team know if these side effects get uncomfortable or don't get better. They can help you manage them.
Your prescriber might ask you to check your blood pressure and heart rate at home. Fetzima (levomilnacipran) can make your blood pressure go up and your heart beat faster. Tell your care team if they stay higher than usual while you're taking this medication.
Avoid drinking alcohol while taking Fetzima (levomilnacipran). It can worsen some side effects like nausea, sleepiness, and dizziness. It can also worsen your depression symptoms in the long run.
Antidepressants like Fetzima (levomilnacipran) can raise the risk of having suicidal thoughts. Call 911 right away if you or someone close to you notices you're thinking about hurting yourself while taking this medication.
Don't lower your dose or suddenly stop taking Fetzima (levomilnacipran) without talking to your prescriber first. Otherwise, you might have withdrawal symptoms like nausea, headache, and sleep problems. Follow your prescriber's instructions to lower your dose slowly over time to stop the medication safely.
Make sure to tell your healthcare team and pharmacist about all the medications you take. Fetzima (levomilnacipran) interacts with some medications, such as other antidepressants, blood thinners, and blood pressure medications. Your care team can check that your medications are safe to take together.
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Frequently asked questions about Fetzima (levomilnacipran)
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What are the risks and warnings for Fetzima (levomilnacipran)?
Fetzima (levomilnacipran) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Suicidal thoughts and behavior
Risk factors: Age under 24 years old | History of depression
Antidepressants like Fetzima (levomilnacipran) can raise the risk of worsening depression. They can also raise the risk of suicidal thoughts or behavior. The risk is higher in people younger than 24 and in people with depression. Talk to your prescriber if you're worried about this risk.
Watch for signs of depression and suicidal thoughts or behavior. This is important to do during the first few months of treatment and when your dose changes. Tell your prescriber if you or your loved ones notice any unusual changes in your mood or behavior while taking this medication. Call 911 if you have suicidal thoughts or behavior.
Serotonin syndrome
Risk factors: Taking other medications that can raise serotonin in the brain
Although it's rare, Fetzima (levomilnacipran) can cause a serious condition called serotonin syndrome. This happens when there's too much serotonin in the brain. The risk is higher if you take other medications that also raise serotonin. Examples include other antidepressants, some opioids, and triptans for migraine. Tell your prescriber and pharmacist about all the medications you take. They can check your risk for serotonin syndrome.
Stop taking Fetzima (levomilnacipran) and get medical help right away if you have any symptoms of serotonin syndrome. This can look like fever, sweating, trouble moving or walking, distress, or hallucinations.
Higher blood pressure and faster heart rate
Risk factors: History of high blood pressure | History of heart problems | History of having problems with blood flow to the brain | History of problems with heart rate
Some people taking Fetzima (levomilnacipran) have had higher blood pressure or a faster heart rate. If you have high blood pressure or take medication for your heart, talk to your prescriber before starting Fetzima (levomilnacipran). They can check if it's safe for you.
Your care team will check your blood pressure and heart rate before you start Fetzima (levomilnacipran). They'll also check at follow-up visits during treatment. They might also ask you to check at home.
Let your care team know if your blood pressure or heart rate stays high while taking Fetzima (levomilnacipran). Your care team can help you manage these side effects. You might need a lower dose or you might have to stop the medication.
Higher risk of bleeding
Risk factors: Taking other medications that can make bleeding more likely (e.g., blood thinners, NSAIDs)
Fetzima (levomilnacipran) can make you more likely to bleed or bruise. This risk is higher if you also take blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil). These medications can also raise the risk of bleeding.
Some bleeding or bruising can be mild, like with nosebleeds. But it can also be more serious. Tell your prescriber if you have any unusual bleeding or bruising or if it doesn't go away while taking Fetzima (levomilnacipran).
Worsening of glaucoma in certain people
Antidepressants like Fetzima (levomilnacipran) can make glaucoma worse in some people. Tell your prescriber if you have narrow-angle eyes or angle-closure glaucoma and haven't had laser surgery. Call your eye specialist right away if you have sudden blurry vision, severe eye pain, or see halos around lights. These could be signs of an angle-closure attack, a serious eye condition that needs urgent care.
Sexual problems
Fetzima (levomilnacipran) can cause sexual problems as a side effect. They can include a lower sex drive, trouble getting or keeping an erection, problems ejaculating, and trouble having an orgasm. Tell your prescriber if you notice any changes in your sex life and when they started. They can check if something else is causing the problem and help you find ways to manage this side effect.
Low sodium levels
Risk factors: Older adults | Taking diuretics (water pills) | Dehydration
Antidepressants like Fetzima (levomilnacipran) can cause low sodium levels in your body. Tell your prescriber if you feel weak, confused, or unsteady. These symptoms can raise your risk of falling. Also tell them if you have trouble thinking clearly, headaches, memory problems, or hallucinations. They can all be signs of low sodium, which should be treated right away.
Mania
Risk factors: Personal or family history of bipolar disorder or mania
Before starting Fetzima (levomilnacipran), tell your prescriber if you or someone in your family has bipolar disorder. They can help decide if this medication is right for you.
Treating someone with bipolar disorder with an antidepressant alone can cause them to have a manic episode. This can look like being overly excited, being very active, talking a lot, or having delusions. Although rare, some people who took Fetzima (levomilnacipran) had symptoms of mania.
Call your prescriber right away if you or someone close to you notices unusual changes in your behavior after you take Fetzima (levomilnacipran).
Fetzima (levomilnacipran) dosage forms
Typical dosing for Fetzima (levomilnacipran)
The typical starting dose is 20 mg by mouth once a day for 2 days. Then, your prescriber will raise your dose to 40 mg by mouth once a day.
As you keep taking the medication, your prescriber will adjust your dose based on how well it works for you and if you have any side effects.
The maximum dose is 120 mg per day. The maximum dose differs if you have kidney problems or if you take certain medications.
Interactions between Fetzima (levomilnacipran) and other drugs
More on Fetzima (levomilnacipran) interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Furazolidone
- Iproniazid
- Isocarboxazid
- Linezolid
- Methylene Blue
- Metoclopramide
- Moclobemide
- Phenelzine
- Procarbazine
- Rasagiline
- Safinamide
- Selegiline
- Tranylcypromine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abciximab
- Aceclofenac
- Acemetacin
- Acenocoumarol
- Alfentanil
- Almotriptan
- Amifampridine
- Amitriptyline
- Amoxapine
- Amphetamine
- Amtolmetin Guacil
- Anagrelide
- Apixaban
- Ardeparin
- Argatroban
- Aspirin
- Atazanavir
- Bemiparin
- Benzhydrocodone
- Benzphetamine
- Bivalirudin
- Boceprevir
- Bromfenac
- Brompheniramine
- Bufexamac
- Buprenorphine
- Bupropion
- Buspirone
- Butorphanol
- Carbamazepine
- Celecoxib
- Ceritinib
- Certoparin
- Chlorpheniramine
- Choline Salicylate
- Cilostazol
- Citalopram
- Clarithromycin
- Clomipramine
- Clonixin
- Clopidogrel
- Cobicistat
- Cocaine
- Codeine
- Conivaptan
- Cyclobenzaprine
- Dabigatran Etexilate
- Dalteparin
- Danaparoid
- Desipramine
- Desirudin
- Desvenlafaxine
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Dextromethorphan
- Diclofenac
- Diflunisal
- Dihydrocodeine
- Dipyridamole
- Dipyrone
- Dolasetron
- Donepezil
- Doxepin
- Drotrecogin Alfa
- Droxicam
- Duloxetine
- Edoxaban
- Eletriptan
- Enoxaparin
- Eptifibatide
- Escitalopram
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenfluramine
- Fenoprofen
- Fentanyl
- Fepradinol
- Feprazone
- Floctafenine
- Fluconazole
- Flufenamic Acid
- Fluoxetine
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Frovatriptan
- Granisetron
- Heparin
- Hydrocodone
- Hydromorphone
- Hydroxytryptophan
- Ibuprofen
- Idelalisib
- Imipramine
- Indinavir
- Indomethacin
- Iobenguane I 131
- Itraconazole
- Ketoconazole
- Ketoprofen
- Ketorolac
- Lasmiditan
- Lepirudin
- Levorphanol
- Lisdexamfetamine
- Lithium
- Lopinavir
- Lorcaserin
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Meperidine
- Metaxalone
- Methadone
- Methamphetamine
- Milnacipran
- Mirtazapine
- Morniflumate
- Morphine
- Morphine Sulfate Liposome
- Nabumetone
- Nadroparin
- Nalbuphine
- Naproxen
- Naratriptan
- Nefazodone
- Nelfinavir
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Nortriptyline
- Ondansetron
- Oxaprozin
- Oxycodone
- Oxymorphone
- Oxyphenbutazone
- Ozanimod
- Palonosetron
- Parecoxib
- Parnaparin
- Paroxetine
- Pentazocine
- Phenindione
- Phenprocoumon
- Phenylbutazone
- Piketoprofen
- Piroxicam
- Posaconazole
- Pranoprofen
- Prasugrel
- Proglumetacin
- Propionic Acid
- Propoxyphene
- Propyphenazone
- Proquazone
- Protein C
- Remifentanil
- Reviparin
- Ritonavir
- Rivaroxaban
- Rizatriptan
- Rofecoxib
- Salicylic Acid
- Salsalate
- Saquinavir
- Sertraline
- Sibutramine
- Simeprevir
- Sodium Salicylate
- St John's Wort
- Sufentanil
- Sulfinpyrazone
- Sulindac
- Sumatriptan
- Tapentadol
- Telaprevir
- Telithromycin
- Tenoxicam
- Tiaprofenic Acid
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tipranavir
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Tramadol
- Trazodone
- Treprostinil
- Valdecoxib
- Venlafaxine
- Vilazodone
- Voriconazole
- Vortioxetine
- Warfarin
- Ziprasidone
- Zolmitriptan
How much does Fetzima (levomilnacipran) cost?
Fetzima (levomilnacipran) contraindications
Allergic reaction to Fetzima (levomilnacipran) or Savella (milnacipran)
Currently take or have taken a monoamine oxidase inhibitor (MAOI) within the last 14 days
What are alternatives to Fetzima (levomilnacipran)?
Major depressive disorder in adults
Generalized anxiety disorder in people age 7 years and older
Diabetic neuropathy (nerve pain caused by high blood sugar) in adults
Fibromyalgia in people age 13 years and older
Long-term pain in the muscles, bones, joints, or tendons in adults
Generalized anxiety disorder - extended-release capsules only
Social anxiety disorder - extended-release capsules and tablets only
Panic disorder - extended-release capsules only
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