levomilnacipran FETZIMA

Class: SNRI
FDA Indications: MDD
Off-Label Use: Anxiety
Prescribing
Forms: 20, 40, 80, 120mg extended-release capsule
Dose Range: 40-120 mg/day
Starting: 20 mg qd x2 days, then 40 mg qd; may ↑ by 40 mg/day q2 days.
Stopping: A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible

NAMI drug fact sheet

Precautions
Contraindications: Concomitant use of MAOIs; uncontrolled narrow angle glaucoma
Serious Side Effects: Serotonin syndrome; ↑ risk of SI in children and young adults; may impair platelet aggregation; SIADH; HTN (~3mmHg ↑ in both systolic & diastolic), ↑ HR
Side Effects: constipation, anorgasmia, hyperhidrosis, nausea, hyponatremia, urinary retention, vomiting, palpitations, erectile dysfunction
Pharmacodynamics
1° MOA: Serotonin Norepinephrine Reuptake Inhibitor
Target: SERT, NET
Pharmacokinetics
t½: 12° TMAX: 6-8°
Substrate of: 3A4
Inhibits: ∅ ; Induces:
Active Metabolites:
DDIs
  • - DO NOT CO-PRESCRIBE WITH MAOIs (need a 14-day washout period)
  • - few known DDIs
  • - 3A4 inhibitors can ↑ levels; likewise, 3A4 inducers can ↓ levels
Misc
  • - the more pharmacologically active isomer derived from the racemic compound milnacipran (Savella)
  • - Levomilnacipran is the most noradrenergically active of the SNRIs
  • - from most to least noradrenergic: levomilnacipran (1:2, 5HT:NE ratio) >> duloxetine (10:1) > desvenlafaxine (12:1) > venlafaxine (30:1)
Special Populations

Category C—Based on animal data, may cause fetal harm.

There are no clinical data regarding the effect on lactation and nursing

No dosage adjustment necessary


Renal elimination has been reported to account for 58% of clearance, so adjust accordingly. CrCl 30-59: max 80 mg/day; CrCl 15-29: max 40 mg/day; ESRD: avoid use

Hepatic elimination is low. Dose adjustment is not recommended.

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Last updated July 08 2018 15:58:23. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.