Fetzima (Levomilnacipran) belongs to the class of medications called antidepressants. Specifically, it is in the family of antidepressants known as serotonin-norepinephrine reuptake inhibitors (SNRIs). It is used to treat the symptoms of major depressive disorder (MDD). It works by affecting the balance of chemicals in the brain that are associated with Depression.

Fetzima (Levomilnacipran) may be available under multiple brand names and/or in several different forms. Any specific brand name of Fetzima (Levomilnacipran) may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of Fetzima (Levomilnacipran) may not be used for all of the conditions discussed here.

Your doctor may have suggested Fetzima (Levomilnacipran) for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking Fetzima (Levomilnacipran), speak to your doctor. Do not stop taking Fetzima (Levomilnacipran) without consulting your doctor.

Do not give Fetzima (Levomilnacipran) to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take Fetzima (Levomilnacipran) if their doctor has not prescribed it.

The recommended starting dose of Fetzima (Levomilnacipran) for adults is 20 mg taken by mouth once daily for 2 days and then increased to 40 mg taken by mouth once daily. Depending on how well this dose works for you, your doctor may gradually increase the dose to a maximum of 120 mg taken once daily.

Swallow the capsule whole with water or other fluid. Do not open, chew, or crush the capsule as this will change how the medication is absorbed by the body and may cause increased side effects. Fetzima (Levomilnacipran) may be taken with food or on an empty stomach.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take Fetzima (Levomilnacipran) exactly as prescribed by your doctor.

If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Fetzima (Levomilnacipran) at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Fetzima (Levomilnacipran). If you are concerned about side effects, discuss the risks and benefits of Fetzima (Levomilnacipran) with your doctor.

The following side effects have been reported by at least 1% of people taking Fetzima (Levomilnacipran). Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• changes in sexual ability
• Constipation
• nausea
• sweating
• trouble sleeping
• vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• difficulty urinating
• new or worsening emotional or behavioural problems
• Hives
• increased blood pressure
• rapid or irregular heartbeat
• rash
• signs of heart problems (e.g., fast, irregular heartbeat or pulse, chest pain, sudden weight gain, difficulty breathing, leg swelling)
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
• symptoms of increased pressure in the eyes (e.g., decreased or blurred vision, eye pain, red eye, swelling of the eye)
• symptoms of low sodium levels in the blood (e.g., achy, stiff or uncoordinated muscles, confusion, tiredness, weakness)
• symptoms of mania (e.g., decreased need for sleep, elevated or irritable mood, racing thoughts)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• seizures
• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• symptoms of serotonin syndrome (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)
• thoughts of self-harm or suicide

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Fetzima (Levomilnacipran).

20 mg
Each capsule with a yellow cap imprinted with "FL" in black ink, and a white body imprinted with "20" in black ink contains Fetzima (Levomilnacipran) hydrochloride equivalent to 20 mg of Fetzima (Levomilnacipran). Nonmedicinal ingredients: ethylcellulose, hypromellose, iron oxide black, iron oxide yellow, povidone, shellac glaze, sugar spheres, talc, titanium dioxide, and triethyl citrate.

40 mg
Each capsule with a yellow cap imprinted with "FL" in black ink, and a yellow body imprinted with "40" in black ink contains Fetzima (Levomilnacipran) hydrochloride equivalent to 40 mg of Fetzima (Levomilnacipran). Nonmedicinal ingredients: ethylcellulose, hypromellose, iron oxide black, iron oxide yellow, povidone, shellac glaze, sugar spheres, talc, titanium dioxide, and triethyl citrate.

80 mg
Each capsule with a pink cap imprinted with "FL" in black ink, and a white body imprinted with "80" in black ink contains Fetzima (Levomilnacipran) hydrochloride equivalent to 80 mg of Fetzima (Levomilnacipran). Nonmedicinal ingredients: ethylcellulose, hypromellose, iron oxide black, iron oxide red, povidone, shellac glaze, sugar spheres, talc, titanium dioxide, and triethyl citrate.

120 mg
Each capsule with a pink cap imprinted with "FL" in black ink, and a pink body imprinted with "120" in black ink contains Fetzima (Levomilnacipran) hydrochloride equivalent to 120 mg of Fetzima (Levomilnacipran). Nonmedicinal ingredients: ethylcellulose, hypromellose, iron oxide black, iron oxide red, povidone, shellac glaze, sugar spheres, talc, titanium dioxide, and triethyl citrate.

Do not take Fetzima (Levomilnacipran) if you:

• are allergic to Fetzima (Levomilnacipran) or any ingredients of the medication
• are taking an MAO inhibitor (e.g., Phenelzine, Tranylcypromine, Moclobemide) or have taken a MAO inhibitor within the past 2 weeks (do not start treatment with an MAO inhibitor until at least 2 weeks after stopping treatment with Fetzima (Levomilnacipran))
• have had a Heart Attack or been treated for a serious heart problem in the last 12 months
• have Congestive Heart Failure
• have uncontrolled rapid heartbeat
• have uncontrolled high blood pressure
• have a history of Stroke or transient ischaemic attacks (TIAs)

There may be an interaction between Fetzima (Levomilnacipran) and any of the following:

• acetylsalicylic acid (ASA)
• alcohol
• alpha-agonists (e.g., Clonidine, methyldopa)
• alpha/beta-agonists (e.g., Epinephrine, norepinephrine)
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine)
• anti-psychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• Apixaban
• Aprepitant
• "azole" antifungals (e.g., itraconazole, ketoconazole, Voriconazole)
• Bicalutamide
• Bromocriptine
• Buspirone
• Cabergoline
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• clopidogrel
• Cobicistat
• conivaptan
• Cyclobenzaprine
• dabigatran
• Dextromethorphan
• dipyridamole
• Dronedarone
• Edoxaban
• ergot alkaloids (e.g., ergotamine, Dihydroergotamine)
• glucosamine
• grapefruit juice
• Heparin
• herbal products that affect blood clotting (e.g., cat's claw, chamomile, fenugreek, evening primrose, feverfew, garlic, ginger, ginseng, turmeric)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• Idelalisib
• Linezolid
• lithium
• low molecular weight heparins (e.g., Dalteparin, Enoxaparin, Tinzaparin)
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• methylene blue
• Metoclopramide
• mifepristone
• Mirtazapine
• monoamine oxidase inhibitors (M.O.S. e.g., linezolid,  moclobemide, Rasagiline, Selegiline, tranylcypromine)
• narcotic pain relievers (e.g., Codeine, Fentanyl, Morphine, Oxycodone)
• nelfinavir
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., Diclofenac, ibuprofen, naproxen)
• Pentoxifylline
• certain protein kinase inhibitors (e.g., Crizotinib, Dasatinib, imatinib)
• Rivaroxaban
• St. John's wort
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, Duloxetine, Venlafaxine)
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• serotonin antagonists (anti-emetic medications; e.g., Granisetron, Ondansetron)
• Tapentadol
• Ticagrelor
• Ticlopidine
• Tramadol
• Trazodone
• tricyclic antidepressants (e.g., Amitriptyline, Clomipramine, Desipramine, Trimipramine)
• "triptan" migraine medications (e.g., Eletriptan, Sumatriptan)
• Tryptophan
• vitamin E
• warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Fetzima (Levomilnacipran). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Fetzima (Levomilnacipran).

Abnormal bleeding: Fetzima (Levomilnacipran), like other similar medications, may cause abnormal bleeding, including bleeding in the stomach or intestines. If you have or have had a history of bleeding disorders, discuss with your doctor how Fetzima (Levomilnacipran) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Fetzima (Levomilnacipran), and whether any special monitoring is needed.

Report any unusual bruising or bleeding to your doctor, especially if you are taking other medications that affect blood clotting. These medications include acetylsalicylic acid (Asa), Clopidogrel, Dipyridamole, nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., Ibuprofen or Naproxen), other anticoagulant medications (e.g., Warfarin), and certain antipsychotic medications.

Blood pressure: Fetzima (Levomilnacipran) may cause an increase in blood pressure or make existing high blood pressure worse. If you have high blood pressure or have any medical conditions that would be affected by increased blood pressure, discuss with your doctor how Fetzima (Levomilnacipran) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Fetzima (Levomilnacipran), and whether any special monitoring is needed.

Bone fracture: Other medications similar to Fetzima (Levomilnacipran) have been linked to an increased risk of bone fractures (breaks). There may be similar risks when taking Fetzima (Levomilnacipran). If you are at risk for developing Osteoporosis, or have osteoporosis or any other illness that increases your risk for breaking bones, discuss with your doctor how Fetzima (Levomilnacipran) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Fetzima (Levomilnacipran), and whether any special monitoring is needed.

Diabetes: How Fetzima (Levomilnacipran) affects a person with diabetes has not been studied. It is possible that Fetzima (Levomilnacipran) may cause a change in glucose tolerance. If you have diabetes or are at risk for developing diabetes, discuss with your doctor how Fetzima (Levomilnacipran) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Fetzima (Levomilnacipran), and whether any special monitoring is needed.

Glaucoma: Fetzima (Levomilnacipran) can cause an increase in the pressure in the eye, making symptoms of glaucoma worse. If you have narrow-angle glaucoma, discuss with your doctor how Fetzima (Levomilnacipran) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Fetzima (Levomilnacipran), and whether any special monitoring is needed.

Kidney function: Kidney Disease or reduced kidney function may cause Fetzima (Levomilnacipran) to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how Fetzima (Levomilnacipran) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Fetzima (Levomilnacipran), and whether any special monitoring is needed.

Heart problems: Fetzima (Levomilnacipran) can cause an increased heart rate and high blood pressure. Together, these side effects can cause congestive heart failure and Angina symptoms to become worse. If you have heart disease such as angina, congestive heart failure, or arrhythmia, discuss with your doctor how Fetzima (Levomilnacipran) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Fetzima (Levomilnacipran), and whether any special monitoring is needed. Contact your doctor as soon as possible if you develop symptoms of heart problems such as shortness of breath, chest pain, rapid heartbeat, or swollen ankles.

Mania: Fetzima (Levomilnacipran) may cause symptoms of mania to worsen or return. If you have a history of mania or bipolar disorder, discuss with your doctor how Fetzima (Levomilnacipran) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Fetzima (Levomilnacipran), and whether any special monitoring is needed.

Seizures: The effect of Fetzima (Levomilnacipran) on a person who has a history of seizures has not been thoroughly studied. If you have a seizure disorder, discuss with your doctor how Fetzima (Levomilnacipran) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Fetzima (Levomilnacipran), and whether any special monitoring is needed.

Serotonin syndrome: Severe reactions are possible when Fetzima (Levomilnacipran) is combined with other medications that act on serotonin, such as tricyclic antidepressants, "triptan" medications for migraine, and some medications to treat nausea due to chemotherapy. These combinations should be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, and changes in mental state including delirium and agitation. Coma and death are possible.

Stopping the medication: Stopping Fetzima (Levomilnacipran) suddenly may lead to side effects such as dizziness, abnormal dreams, numbness or tingling sensations, agitation, anxiety, nausea, vomiting, sweating, or other symptoms. If you are thinking of stopping the medication, check with your doctor first. Your doctor may want you to decrease the dose of the medication gradually when it is time to stop taking Fetzima (Levomilnacipran).

Suicidal or agitated behaviour: People taking Fetzima (Levomilnacipran) may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These behavioural changes may be more likely to occur in children and adolescents, however they are possible for all age groups that use Fetzima (Levomilnacipran). These symptoms may occur within several weeks after starting Fetzima (Levomilnacipran). If you experience these side effects or notice them in a family member who is taking Fetzima (Levomilnacipran), contact your doctor immediately. You should be closely monitored by your doctor for emotional and behavioural changes while taking Fetzima (Levomilnacipran).

Urinary problems: Fetzima (Levomilnacipran) can affect urinary tract function. It may cause difficulty starting urine flow, completely emptying the bladder or contribute to incontinence (urine leakage). If you have a history of urinary retention or benign prostatic hypertrophy, or other prostate problems, discuss with your doctor how Fetzima (Levomilnacipran) may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Fetzima (Levomilnacipran), and whether any special monitoring is needed.

Pregnancy: Fetzima (Levomilnacipran) should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Fetzima (Levomilnacipran), contact your doctor immediately.

Breast-feeding: It is not known if Fetzima (Levomilnacipran) passes into breast milk. If you are a breast-feeding mother and are taking Fetzima (Levomilnacipran), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and effectiveness of Fetzima (Levomilnacipran) for people under 18 years of age have not been established. The use of Fetzima (Levomilnacipran) by children and adolescents less than 18 years old may cause behavioural and emotional changes, such as suicidal thoughts and behaviour.

Seniors: Seniors may need lower doses of Fetzima (Levomilnacipran) and should be closely monitored by their doctor when taking Fetzima (Levomilnacipran).