What is this medication?
Antidepressant, Serotonin/Norepinephrine Reuptake Inhibitor
Indicated for treatment of major depressive disorder.
“ALERT: US Boxed Warning
Suicidality and antidepressant drugs:
Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients older than 24 years; there was a reduction in risk with antidepressant use in patients 65 years and older.
In patients of all ages who are started on antidepressant therapy, monitor closely for worsening and for emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber.
Levomilnacipran is not approved for use in pediatric patients.”
How does this medication work?
Levomilnacipran, the more active enantiomer of milnacipran, is a strong inhibitor of norepinephrine and serotonin reuptake.
How should I take this medication?
Oral: Initial: 20 mg once daily for 2 days; increase to 40 mg once daily; may then be increased in increments of 40 mg at intervals of 2 or more days; Maintenance: 40 to 120 mg once daily; Maximum: 120 mg/day
How to Take: Follow instructions provided by physician/pharmacy label, swallow whole with or without food, take consistently at same times each day unless otherwise directed, store at room temperature.
You Need to Avoid: Alcohol can increase the release rate of medication from the slow release formulation so it should be avoided. Do not stop this medication without tapering dose down over time to prevent withdrawal symptoms (nausea, diarrhea, sweating, headaches, agitation, insomnia, anxiety, tremor, vertigo, dizziness).
What should I watch for while using this medication?
Before starting Levomilnacipran, Fetzima make sure your physician is aware of any allergies or medications you currently take, if you have bipolar disorder, kidney disease, a seizure disorder, or are pregnant or breastfeeding. This medication has risk of causing serotonin syndrome especially if combined with other serotonergic drugs. This medication, like most antidepressants, may rarely increase risk of suicidal ideation so must be used with caution and any major changes in personality or mood should be reported to physician immediately. Use of this medication has also been associated with rare but serious reactions such as syndrome of inappropriate antidiuretic hormone (SIADH), hyponatremia, bleeding events, cardiovascular effects, increased risk of bone fracture, ocular effects, and urinary retention.
What if I miss a dose?
If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.
How should I store this medication?
Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.
What are the possible side effects of using this medication?
Nausea, orthostatic hypotension
Note this is not a complete list of side effects, only common ones.
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