Jeffrey Panko NP Psychiatry · Patient education
Levomilnacipran
Fetzima / Extended-release capsules
A guide for adults taking levomilnacipran.
Follow the directions on your prescription and your provider's recommendations.
Formulations: Extended-release capsules are taken once daily. Kidney impairment and some interacting medicines require dose limits.
What it is used for
Levomilnacipran treats major depression in adults. It is different from milnacipran, which is used for fibromyalgia in the United States.
How it works
It inhibits norepinephrine and serotonin reuptake. Norepinephrine effects can contribute to increased pulse, blood pressure, or difficulty urinating.
What to expect over time
Sleep, energy, or appetite may change before mood improves. Benefit usually builds over several weeks; some conditions need a longer trial at a useful dose.
Track the symptoms you are treating and how you manage daily activities. Keep follow-up appointments. Schedule an earlier appointment if your mood gets worse.
Taking your medication
- Take once daily, with or without food.
- Swallow capsules whole; do not open, crush, or chew.
- If you miss a dose, take it when you remember unless it is almost time for the next dose. Then skip it. Do not double a dose.
- Consult with your provider before stopping; gradual reduction is recommended.
When to get help
Emergency symptoms. Get emergency care for a seizure, severe allergic reaction, or sudden eye pain with vision changes. Fever with agitation, diarrhea, and stiff or twitching muscles may be serotonin syndrome and needs urgent assessment.
Prompt medical advice. Seek prompt care if unable to urinate. Report a persistently racing pulse, marked blood-pressure symptoms, or worsening mood.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Nausea, dry mouth, or constipation
- Sweating, headache, or dizziness
- Sleep changes or reduced appetite
- Sexual side effects; increased blood pressure or pulse
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
Antidepressants can increase suicidal thoughts in people under 25. Watch for changes in mood or behavior at any age, especially when starting treatment or changing a dose.
Tell your provider about emotional numbness, unusual agitation, or a reduced need for sleep with increased energy. These changes may call for a treatment adjustment.
Have blood pressure checked before starting and during treatment. Report unusual bleeding, severe headache, confusion, or marked weakness; low sodium is one possible cause.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Discuss any history of mania or bipolar disorder, seizures, heart disease, glaucoma, and kidney or liver problems.
Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.
Discuss urinary hesitancy or retention, prostate problems, uncontrolled blood pressure, and kidney disease.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
MAOIs require a drug-specific switching interval. Other serotonergic medicines can cause serotonin syndrome; aspirin, NSAIDs, and anticoagulants add bleeding risk.
Strong CYP3A inhibitors require a lower maximum dose. Stimulants and decongestants may add pulse or blood-pressure effects.
Everyday tips
A regular dose time and refill reminder can help prevent missed doses.
Bring a few specific observations to appointments: sleep, motivation, anxiety, and activities that have become easier or harder.
Your questions answered
Can I stop when I feel better?
Consult with your provider. Continuing treatment after improvement can reduce the chance that symptoms return. Most antidepressants should be reduced gradually to limit withdrawal symptoms.
What if I have sexual side effects?
Changes in desire, arousal, or orgasm are worth discussing. Your provider can review the dose or treatment options; do not stop or skip doses on your own.
Storage and safety
Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.