Levomilnacipran: Uses, Dosage, and Side Effects Overview

Summary of Levomilnacipran Uses and Key Points

Levomilnacipran is a prescription medication primarily used to treat major depressive disorder (MDD) in adults. It works by balancing specific brain chemicals, which can help improve mood and boost energy levels. As a member of the serotonin-norepinephrine reuptake inhibitors (SNRIs) class, Levomilnacipran is effective in managing symptoms of depression. Always consult a healthcare provider before starting or adjusting your dosage. For personalized advice, you can connect with one of our telemedicine providers.

Medication Names: Brand and Generic

US Brand Name: Fetzima

Generic Name: Levomilnacipran

The generic name, Levomilnacipran, refers to the active ingredient in the medication, while the brand name, Fetzima, is the name given by the manufacturer.

Pharmacologic Category: SNRI Antidepressants

Levomilnacipran belongs to the serotonin-norepinephrine reuptake inhibitors (SNRIs) category, a group of medications commonly prescribed for depression. Other medications in this class include:

1. Venlafaxine (Effexor)
2. Duloxetine (Cymbalta)
3. Desvenlafaxine (Pristiq)

Levomilnacipran Dosage Guidelines

Levomilnacipran is primarily prescribed to treat major depressive disorder (MDD) in adults. Below are the recommended dosage guidelines for this condition. Always consult your healthcare provider before making any changes to your medication regimen. If you have questions or need assistance, our telemedicine providers are here to help.

Dosage for Major Depressive Disorder (MDD)

1. Initial Dose: 20 mg once daily for the first two days
2. Maintenance Dose: Increase to 40 mg once daily
3. Maximum Dose: Up to 120 mg once daily
4. Duration: The length of treatment varies based on individual response and should be determined by your healthcare provider.

Off-Label Uses and Other Conditions

While Levomilnacipran is primarily approved for MDD, some healthcare providers may prescribe it off-label for other conditions. If you are considering this medication for a purpose other than its approved use, consult your doctor first. Our telemedicine team is available to address any questions or concerns you may have.

Dosage Forms and Strengths

Levomilnacipran is available in extended-release capsules with the following strengths:

1. 20 mg
2. 40 mg
3. 80 mg
4. 120 mg

Administration Instructions for Levomilnacipran

Levomilnacipran should be taken once daily, with or without food. Swallow the capsule whole—do not crush, chew, or open it. To maintain consistent levels of the medication in your body, take it at the same time each day. If you miss a dose, take it as soon as you remember, unless it is close to the time of your next scheduled dose. In that case, skip the missed dose and continue with your regular schedule. Never take two doses at once. Always follow your healthcare provider’s instructions carefully.

Levomilnacipran Side Effects and Adverse Reactions

Like all medications, Levomilnacipran may cause side effects. Some are more common and manageable, while others are rare but may require immediate medical attention. If you experience any concerning symptoms, contact your healthcare provider promptly. Our telemedicine providers are available to help you manage any side effects or concerns.

Common Side Effects (Occur in More Than 10% of Patients)

1. Nausea: A feeling of queasiness, which often improves over time.
2. Increased Heart Rate: A faster-than-normal heartbeat.
3. Constipation: Difficulty with bowel movements, which can often be managed with dietary changes or over-the-counter remedies.
4. Excessive Sweating: Increased perspiration, particularly during physical activity.

Less Common Side Effects (Occur in 1-10% of Patients)

1. Dizziness: A sensation of lightheadedness or unsteadiness, especially when standing up quickly.
2. Insomnia: Trouble falling or staying asleep.
3. Dry Mouth: A lack of saliva, which may cause your mouth to feel dry or sticky.

Serious Side Effects (Rare, but Require Immediate Medical Attention)

1. High Blood Pressure: Levomilnacipran can elevate blood pressure, so regular monitoring is recommended.
2. Serotonin Syndrome: A rare but serious condition characterized by symptoms such as confusion, rapid heart rate, and muscle stiffness. Seek immediate medical care if these symptoms occur.
3. Increased Risk of Suicidal Thoughts: This medication may heighten the risk of suicidal thoughts or behaviors, particularly in young adults. If you notice any changes in mood or behavior, contact your healthcare provider immediately.

Contraindications for Levomilnacipran

A contraindication refers to a condition or circumstance in which using a medication, such as **Levomilnacipran**, could pose significant risks or harm. If you have any of the conditions listed below, **Levomilnacipran** may not be a safe option for you. Always consult your healthcare provider before starting any new medication. If you suspect that any of these conditions apply to you, consider scheduling a consultation with a qualified healthcare professional, either in person or through telemedicine.

Uncontrolled Narrow-Angle Glaucoma: **Levomilnacipran** can increase pressure within the eye, which may exacerbate symptoms of glaucoma. This makes it unsuitable for individuals with uncontrolled narrow-angle glaucoma.

Severe Kidney Disease: Because **Levomilnacipran** is primarily eliminated from the body through the kidneys, individuals with severe kidney impairment may have difficulty processing the medication. This can lead to higher levels of the drug in the body, increasing the likelihood of adverse effects.

Allergy to Levomilnacipran: If you have ever experienced an allergic reaction to **Levomilnacipran** or any of its ingredients, you should avoid taking this medication. Allergic reactions can range from mild to severe and should not be ignored.

Use of Monoamine Oxidase Inhibitors (MAOIs): Combining **Levomilnacipran** with MAOIs, such as phenelzine or tranylcypromine, or taking it within 14 days of stopping an MAOI, can lead to dangerous interactions. One such interaction is serotonin syndrome, a potentially life-threatening condition characterized by symptoms like agitation, rapid heart rate, and high fever.

Drug-to-Drug Interactions with Levomilnacipran

**Levomilnacipran** has the potential to interact with other medications, which may increase the risk of side effects or reduce the effectiveness of treatment. It is essential to inform your healthcare provider about all the medications you are currently taking, including prescription drugs, over-the-counter medications, vitamins, and supplements. Below are some common medications and substances that may interact with **Levomilnacipran**:

1. SSRIs and SNRIs: Medications such as fluoxetine (Prozac), sertraline (Zoloft), and venlafaxine (Effexor) can increase the risk of serotonin syndrome when used alongside **Levomilnacipran**.
2. Triptans: Migraine treatments like sumatriptan (Imitrex) and rizatriptan (Maxalt) may also elevate the risk of serotonin syndrome when combined with **Levomilnacipran**.
3. Anticoagulants and Antiplatelet Drugs: Blood-thinning medications, including warfarin (Coumadin) and aspirin, may heighten the risk of bleeding when taken with **Levomilnacipran**.
4. St. John’s Wort: This herbal supplement can increase serotonin levels, potentially leading to serotonin syndrome when used in combination with **Levomilnacipran**.
5. Diuretics: Medications like furosemide (Lasix) may raise the risk of low sodium levels (hyponatremia) when taken with **Levomilnacipran**.

Levomilnacipran and Pregnancy

Is it safe to take **Levomilnacipran** during pregnancy? The safety of **Levomilnacipran** for pregnant individuals has not been thoroughly established. Limited data is available regarding its use during pregnancy, and animal studies have suggested potential risks to the developing fetus. If you are pregnant or planning to become pregnant, it is crucial to discuss the potential risks and benefits with your healthcare provider. They may recommend alternative treatments or closely monitor your condition if **Levomilnacipran** is deemed necessary.

Levomilnacipran While Breastfeeding

Is it safe to take **Levomilnacipran** while breastfeeding? **Levomilnacipran** may pass into breast milk, and its effects on a nursing infant are not yet fully understood. If you are breastfeeding, it is important to weigh the potential risks and benefits with your healthcare provider. In some cases, your provider may suggest alternative treatments or recommend discontinuing breastfeeding while taking this medication.

Estimated Cost of Levomilnacipran (Fetzima)

The cost of a 30-day supply of **Levomilnacipran (Fetzima)** without insurance can vary. With a GoodRx coupon, the price typically ranges from $350 to $400. However, costs may differ depending on the pharmacy and your location. To manage expenses, consider exploring discount programs or discussing cost-saving options with your healthcare provider.

Possible Alternatives to Levomilnacipran

Depending on your condition, alternative treatments or lifestyle adjustments may help manage your symptoms effectively. It’s important to consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are here to support you in exploring these options.

Major Depressive Disorder: Alternatives to Levomilnacipran for managing depression include other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) like sertraline or fluoxetine. Non-medication options, such as cognitive-behavioral therapy (CBT), regular physical activity, and mindfulness practices, can also play a significant role in improving symptoms.

Generalized Anxiety Disorder: Medications such as buspirone (Buspar) or benzodiazepines (e.g., lorazepam) may be considered as alternatives. Therapy options, including CBT and relaxation techniques, can also provide effective symptom relief.

Social Anxiety Disorder: SSRIs or beta-blockers, such as propranolol, may be helpful alternatives. Additionally, exposure therapy and social skills training can enhance social interactions and reduce anxiety in social settings.

Panic Disorder: SSRIs, benzodiazepines, or CBT are commonly used alternatives for managing panic disorder. Techniques like breathing exercises and mindfulness practices can further help reduce the intensity and frequency of panic attacks.

Obsessive-Compulsive Disorder: SSRIs, such as fluoxetine, or tricyclic antidepressants like clomipramine (Anafranil), are frequently prescribed alternatives. Exposure and response prevention (ERP) therapy is a highly effective approach for managing OCD symptoms.

Post-Traumatic Stress Disorder: SSRIs and trauma-focused therapies, such as Eye Movement Desensitization and Reprocessing (EMDR), are widely recognized as effective alternatives for managing PTSD symptoms.

Chronic Pain: Non-opioid pain relievers, physical therapy, and integrative approaches like yoga or acupuncture may be considered as alternatives to Levomilnacipran for chronic pain management.

Fibromyalgia: Medications such as duloxetine (Cymbalta) or pregabalin (Lyrica) are commonly used alternatives. Incorporating regular exercise and stress management techniques can also help alleviate fibromyalgia symptoms.

Attention Deficit Hyperactivity Disorder (ADHD): Stimulant medications like methylphenidate (Ritalin) or non-stimulants such as atomoxetine (Strattera) are frequently prescribed alternatives. Behavioral therapy can also be an effective tool for managing ADHD symptoms.

Seasonal Affective Disorder: Light therapy, SSRIs, and lifestyle modifications, such as spending more time outdoors, may serve as alternatives to Levomilnacipran for addressing seasonal affective disorder.

Recent Updates on Levomilnacipran Research

Recent studies on Levomilnacipran have explored its effectiveness in treating major depressive disorder and its potential benefits for conditions like fibromyalgia and chronic pain. Preliminary findings suggest that Levomilnacipran may help alleviate pain symptoms in addition to its antidepressant effects. However, further research is necessary to confirm these findings and better understand its broader applications.

Ongoing research is also examining the long-term safety of Levomilnacipran, particularly for individuals managing both mental health conditions and chronic pain. Be sure to consult your healthcare provider to discuss the latest research and how it may influence your treatment plan.

James Kingsley

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