Levomilnacipran ($ Fetzima)
SNRI antidepressant
- Major depression2
- Fibromyalgia
- Chronic pain
Features
Dosing
Start 20 mg 1 qd x2days, then 40 mg qd, max 120 mg qd.
INTERACTIONS: Lower dose 50% with CYP3A4 inhibitors (nefazodone, grapefruit juice, ketoconazole, clarithromycin, ritonavir). Raise dose x1.3 if using with carbamazepine.
Management
Has bupropion-like effects. Isomer of milnacipran (Savella)
TOLERABILITY: Nausea, sexual dysfunction, sleep disruption, restless legs. Warning: osteopenia in post-menopausal women.
RISKS: Osteopenia in post-menopausal women. Hyponatremia. Serotonin syndrome.
EMR Text
Depression
Levomilnacipran use based on FDA approval in major depressive disorder.
Levomilnacipran side effects reviewed with patient.