Fetzima (levomilnacipran) is a selective serotonin and norepinephrine reuptake inhibitor antidepressant (SNRI). Levomilnacipran affects chemicals in the brain that may become unbalanced and cause depression.
Fetzima is used to treat major depressive disorder.
A similar medicine called milnacipran (Savella) is used to treat a chronic pain disorder called fibromyalgia. Fetzima should not be used to treat fibromyalgia.
Important information
You should not use Fetzima if you have untreated or uncontrolled narrow-angle glaucoma.
Do not use Fetzima if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine. Do not use an MAO inhibitor within 7 days after you stop taking this medicine.
Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using Fetzima. Your family or other caregivers should also be alert to changes in your mood or symptoms.
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.
Do not give this medicine to anyone younger than 18 years old without the advice of a doctor. Fetzima is not approved for use in children.
Before taking this medicine
Do not use Fetzima if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine. Do not use an MAO inhibitor within 7 days after you stop taking Fetzima.
You should not use Fetzima if you are allergic to levomilnacipran or milnacipran (Savella), or if you have untreated or uncontrolled narrow-angle glaucoma.
To make sure Fetzima is safe for you, tell your doctor if you have:
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heart disease, high blood pressure, heart rhythm disorder;
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a bleeding or blood clotting disorder such as hemophilia;
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bipolar disorder (manic depression);
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narrow-angle glaucoma;
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seizures or epilepsy;
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kidney disease;
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low levels of sodium in your blood;
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bladder obstruction or other urination problems;
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if you drink large amounts of alcohol; or
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if you take a diuretic ("water pill") or use migraine headache medicine.
Some young people have thoughts about suicide when first taking an antidepressant. Your doctor will need to check your progress at regular visits while you are using Fetzima. Your family or other caregivers should also be alert to changes in your mood or symptoms.
FDA pregnancy category C. It is not known whether Fetzima will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.
See also: Pregnancy and breastfeeding warnings (in more detail)
It is not known whether levomilnacipran passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using this medicine.
Do not give this medicine to anyone younger than 18 years old without the advice of a doctor. Fetzima is not approved for use in children.
How should I take Fetzima?
Take Fetzima exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.
You may take Fetzima with or without food.
Do not crush, chew, break, or open a capsule. Swallow it whole.
Your blood pressure and heart rate will need to be checked often.
Do not stop using Fetzima 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.
Fetzima dosing information
Usual Adult Dose for Depression:
Initial dose: 20 mg orally once a day for 2 days then increase to 40 mg orally once a day. Dose may be increased in increments of 40 mg at intervals of 2 or more days based on tolerability and efficacy.
Maintenance dose: 40 to 120 mg orally once a day
Maximum dose: 120 mg orally once a day
Approved indication: Major depressive disorder (MDD)
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
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 Fetzima?
Avoid drinking alcohol. It may raise your blood levels of Fetzima.
Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with Fetzima may cause you to bruise or bleed easily.
This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Fetzima side effects
Get emergency medical help if you have any of these signs of an allergic reaction to Fetzima: 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:
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blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
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painful or difficult urination;
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seizure (convulsions);
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easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;
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pounding heartbeats or fluttering in your chest;
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high levels of serotonin in the body--agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting; or
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low levels of sodium in the body--headache, confusion, slurred speech, severe weakness, muscle cramps, loss of coordination, feeling unsteady, fainting, shallow breathing.
Older adults may be more sensitive to the side effects of this medication.
Common Fetzima side effects may include:
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nausea, vomiting, constipation;
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vision changes;
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increased sweating;
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fast heart rate; or
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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.
See also: Side effects (in more detail)
What other drugs will affect Fetzima?
Taking this medicine with other drugs that make you sleepy or slow your breathing can worsen these effects. Ask your doctor before taking Fetzima with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Fetzima, especially:
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any other antidepressant;
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sibutramine;
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tramadol;
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St. John"s wort;
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tryptophan (sometimes called L-tryptophan);
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a diuretic or "water pill";
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a blood thinner (warfarin, Coumadin, Jantoven);
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medicine to treat mood disorders, thought disorders, or mental illness--buspirone, lithium, and many others; or
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migraine headache medicine--sumatriptan, rizatriptan, zolmitriptan, and others.
This list is not complete. Other drugs may interact with levomilnacipran, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
