Home Drug Guide Levomilnacipran

Drug Guide

Generic Name

Levomilnacipran

Brand Names Fetzima

Classification

Therapeutic: Antidepressant, Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)

Pharmacological: Selective serotonin and norepinephrine reuptake inhibitor

FDA Approved Indications

  • Major depressive disorder

Mechanism of Action

Levomilnacipran inhibits the reuptake of serotonin and norepinephrine, increasing their levels in the synaptic cleft, which helps alleviate depressive symptoms.

Dosage and Administration

Adult: Start with 20 mg once daily; can be titrated up to 40-120 mg/day based on response and tolerability. Usually takes at least 2 weeks to see full effect.

Pediatric: Not approved for pediatric use.

Geriatric: Begin at the lower end of dosing range, monitor closely for side effects.

Renal Impairment: Dose adjustment may be necessary; consult product labeling.

Hepatic Impairment: Use with caution; no specific dosage adjustment provided.

Pharmacokinetics

Absorption: Well-absorbed after oral administration.

Distribution: Widely distributed; protein binding approximately 15%.

Metabolism: Minimal hepatic metabolism; primarily excreted unchanged.

Excretion: Renal excretion (~50-60%), some in feces.

Half Life: About 12 hours, allowing once or twice daily dosing.

Contraindications

  • Hypersensitivity to levomilnacipran or other SNRIs.
  • Concurrent use with monoamine oxidase inhibitors (MAOIs).

Precautions

  • History of hypertension, bipolar disorder, seizures, or narrow-angle glaucoma. Use with caution in patients with a history of serotonin syndrome or bleeding risk. Can increase blood pressure; monitor blood pressure regularly. Possible increased risk of suicidal thoughts in young adults and adolescents.

Adverse Reactions - Common

  • Nausea (Common)
  • Dry mouth (Common)
  • Headache (Common)
  • Increased blood pressure (Common)

Adverse Reactions - Serious

  • Serotonin syndrome (Rare)
  • Hypertensive crisis or increased blood pressure (Less common)
  • QT prolongation (Rare)

Drug-Drug Interactions

  • Serotonergic drugs (e.g., SSRIs, SNRIs, triptans) - risk of serotonin syndrome
  • Blood pressure medications - possible increased effect
  • MAOIs - contraindicated

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure regularly; assess for suicidal ideation; monitor for signs of serotonin syndrome.

Diagnoses:

  • Risk for hypertension
  • Imbalanced nutrition: less than body requirements due to nausea
  • Risk for suicidal ideation

Implementation: Start at recommended dose; titrate cautiously; instruct patient to report side effects.

Evaluation: Effectiveness in alleviating depressive symptoms and tolerability of side effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not abruptly stop medication.
  • Avoid alcohol and illicit drugs.
  • Report signs of increased blood pressure, serotonin syndrome (agitation, hallucinations, rapid heart rate), or worsening depression.

Special Considerations

Black Box Warnings:

  • Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults.
  • Serotonin syndrome risk when combined with serotonergic agents.

Genetic Factors: Genetic polymorphisms may affect drug metabolism and response.

Lab Test Interference: May affect blood pressure measurements.

Overdose Management

Signs/Symptoms: Nausea, vomiting, increased blood pressure, tachycardia, seizures, serotonin syndrome symptoms.

Treatment: Supportive care, activated charcoal if ingestion is recent, symptomatic treatment, and monitoring. Hemodialysis may be considered in severe cases.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable for manufacturer-recommended shelf life.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.