Home Drug Guide Levomilnacipran Hydrochloride

Drug Guide

Generic Name

Levomilnacipran Hydrochloride

Brand Names Fetzima

Classification

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

Pharmacological: Selective serotonin and norepinephrine reuptake inhibitor

FDA Approved Indications

Major depressive disorder (MDD)

Mechanism of Action

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

Dosage and Administration

Adult: Start at 40 mg once daily, may titrate up to 80 mg once daily based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: No specific dosage adjustment required; monitor renal function.

Renal Impairment: Reduce dose in patients with severe renal impairment; specific adjustments should be guided by renal function.

Hepatic Impairment: Use with caution; no specific dose recommendations established.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; protein binding approximately 15%.

Metabolism: Primarily metabolized via hydrolysis and CYP3A4.

Excretion: Mostly in urine, both as unchanged drug and metabolites.

Half Life: Approximately 12 hours, allowing once-daily dosing.

Contraindications

Concomitant use of monoamine oxidase inhibitors (MAOIs)
Hypersensitivity to levomilnacipran

Precautions

History of bipolar disorder, seizure disorders, suicidal thoughts, or tendencies; avoid abrupt discontinuation to prevent withdrawal symptoms.
Monitor blood pressure regularly, as hypertensive episodes can occur.

Adverse Reactions - Common

Nausea (Frequent)
Sweating (Frequent)
Constipation (Frequent)
Dizziness (Frequent)
Insomnia (Frequent)

Adverse Reactions - Serious

Hypertension (Uncommon)
Serotonin syndrome (Rare)
Increased risk of suicidal thoughts in young adults (Uncommon)

Drug-Drug Interactions

Use with other serotonergic drugs can increase the risk of serotonin syndrome.
CYP3A4 inhibitors may increase levomilnacipran blood concentrations.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, mental health status, and renal function.

Diagnoses:

Risk for hypertension
Risk for suicidal ideation
Altered mental status

Implementation: Administer once daily, preferably in the morning.

Evaluation: Assess therapeutic response, side effects, and adherence.

Patient/Family Teaching

Take medication exactly as prescribed.
Report any signs of increased blood pressure, mood changes, or suicidal thoughts.
Avoid sudden discontinuation—consult healthcare provider.
Limit alcohol and sedatives, as they can enhance side effects.

Special Considerations

Black Box Warnings:

Suicidality in children, adolescents, and young adults with MDD.
Increased risk of hyponatremia, especially in elderly patients.

Genetic Factors: Variability in CYP3A4 activity may affect drug levels.

Lab Test Interference: No significant interference reported.

Overdose Management

Signs/Symptoms: Hypertension, tachycardia, agitation, coma.

Treatment: Supportive care, monitor vital signs, activated charcoal if ingestion was recent, and symptomatic treatment.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable when stored properly.