Fetzima (Levomilnacipran) – Oral

Warning:

The Food and Drug Administration (FDA) assigned a black box warning to Fetzima (Levomilnacipran). Antidepressants—like Fetzima—might increase the likelihood of suicidal thoughts and behaviors in children and young adults. Fetzima isn't FDA approved for use in children.

What Is Fetzima?

Fetzima (levomilnacipran) is a medication option for the treatment of depression. Fetzima is a serotonin-norepinephrine reuptake inhibitor (SNRI). As an SNRI, Fetzima works by increasing the amounts of the naturally occurring brain chemicals serotonin and norepinephrine.

Fetzima is available as a prescription capsule.

Drug Facts

Generic Name: Levomilnacipran

Brand Name(s): Fetzima

Drug Availability: Prescription

Therapeutic Classification: Serotonin-norepinephrine reuptake inhibitor (SNRI)

Available Generically: No

Controlled Substance: No

Administration Route: Oral (by mouth)

Active Ingredient: Levomilnacipran

Dosage Form(s): Capsule

What Is Fetzima Used For?

Fetzima treats depression.

Millions of people in the United States have experienced depression. Symptoms of depression include:

  • Appetite changes
  • Changes in sleeping habits
  • Feelings of hopelessness and guilt
  • Loss of interest in previously enjoyable activities
  • Low energy
  • Thoughts of suicide
  • Trouble with concentration (focus)

How to Take Fetzima

Take Fetzima by mouth once daily with or without food.

Fetzima capsules must be swallowed whole. Don't open, chew, or crush capsules.

Storage

When you receive Fetzima from the pharmacy, keep it at room temperature around 77 degrees Fahrenheit—with a short-term safety storage range of 59 degrees to 86 degrees.

Keep your medications tightly closed and out of the reach of children and pets, ideally locked in a cabinet or closet. Do not store this medicine in the bathroom.

Avoid pouring unused and expired drugs down the drain or in the toilet. Visit the FDA website to learn where and how to discard of unused and expired medications. You can also find and use disposal boxes in your area. Ask your pharmacist or healthcare provider if you have any questions about the best ways to dispose of your medications.

If you plan to travel with Fetzima, become familiar with your final destination's regulations. Checking with the U.S. Embassy or U.S. Consulate might be a helpful resource. In general, however, make a copy of your Fetzima prescription. It's also a good idea to keep your medication in its original container from your pharmacy with your name on the label. If you have any questions about traveling with your medicine, ask your pharmacist or healthcare provider.

How Long Does Fetzima Take to Work?

You might notice some improvement in your symptoms within the one to two weeks of taking Fetzima. Maximum effectiveness, however, might require six to eight weeks.

Off-Label Uses

Fetzima doesn't currently have any off-label uses.

What Are the Side Effects of Fetzima?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Common side effects with Fetzima may include:

Severe Side Effects

Serious side effects with Fetzima may include:

Other severe symptoms may also include:

  • Discontinuation (withdrawal) symptoms: If you abruptly stop taking Fetzima, you might experience withdrawal symptoms, such as dizziness, headache, mood changes, and sleeping problems. Other potential symptoms may include ringing ears, seizures, and numbness or tingling sensation.
  • Hyponatremia: Fetzima might cause hyponatremia, a condition of low sodium blood levels. If you have low sodium, you might experience symptoms of concentration (focus) problems, confusion, and memory problems. You may also feel unsteady and have more falls. Severely low sodium levels can even result in coma, hallucinations, seizures, and death.
  • Mania or hypomania: If you have bipolar disorder, Fetzima might switch you from an episode of depression to a period of mania or hypomania. Mania symptoms start with an elevated mood and improved productivity, but mania can quickly change into an irritable mood, impulsive decisions, and psychosis.
  • Severe allergic reaction: If you have a severe allergic reaction to Fetzima, you might experience rash, swelling, and breathing difficulties.
  • Serotonin syndrome: Fetzima may increase your risk of a rare but life-threatening condition called serotonin syndrome. In serotonin syndrome, your serotonin levels are too high. Your risk is further increased if you take Fetzima with other medication that raises serotonin levels. Symptoms may include seizures, sweating, and tremors.
  • Sexual side effects: Fetzima is linked to sexual-related effects, such as low sex drive (libido) or erectile dysfunction. There may also be problems with having an orgasm or ejaculation.

Get medical help right away if you develop these serious side effects. Call 911 if your symptoms feel life-threatening.

Long-Term Side Effects

Long-term use of Fetzima isn't generally linked to side effects.

Quickly discontinuing Fetzima after long-term use, however, may result in some withdrawal symptoms.

Report Side Effects

Fetzima may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Fetzima Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (extended-release capsules):
    • For depression:
      • Adults—At first, 20 milligrams (mg) once a day. After 2 days, the dose will be increased to 40 mg once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 120 mg per day.
      • Children—Use is not recommended.

Modifications

The following modifications (changes) should be kept in mind when using Fetzima:

Severe allergic reaction: Avoid using Fetzima if you have a known allergy to it or its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: In animal studies, Fetzima was found to have negative effects on the fetus. Not enough is known about the safety and effectiveness of Fetzima in pregnant humans and their fetuses.

Pregnant people might have a higher risk of bleeding when giving birth if taking Fetzima. There also have been reports of side effects that have required hospitalization and tube feeding in newborns exposed to Fetzima during late pregnancy (e.g., third trimester). Untreated depression during pregnancy also comes with certain risks.

Talk with your healthcare provider if you plan to become pregnant or are pregnant. They can help you weigh the benefits and risks of Fetzima during pregnancy. You can also enroll in a pregnancy exposure registry by visiting the National Pregnancy Registry for Antidepressants website or calling 844-405-6185.

Breastfeeding: Low amounts of Fetzima might be present in human breast milk. Fetzima doesn't appear to negatively affect milk production. However, Fetzima is an SNRI. Some nursing infants exposed to SNRIs through breast milk have become agitated or irritable, and have had trouble feeding and gaining weight.

Until more is known, Fetzima should be used with caution while nursing. Talk with your healthcare provider if you plan to breastfeed, to weigh the benefits and harms of Fetzima while nursing. They can also discuss different ways available to feed your baby.

Older adults over 65: Clinical studies didn't include a large percentage of people in this age group. In general, however, older adults tend to have medical conditions that may make them more sensitive to Fetzima's side effects, such as low sodium levels. As a result, Fetzima should be used with caution in older adults.

Children: Fetzima hasn't been studied in children.

Kidney problems: Individuals with kidney problems may not be able to clear medication from their bodies as quickly. This means the medicine stays in the body longer and can have increased side effects. For this reason, your healthcare provider will likely adjust your Fetzima dosage if you have moderate or severe kidney impairment.

Bipolar disorder: Fetzima might cause a change from a depressive episode to a manic one. Therefore, your healthcare provider may screen you for bipolar disorder before starting Fetzima. If you do have bipolar disorder, your healthcare provider will monitor and manage possible mania symptoms.

High blood pressure: Fetzima might cause an increase in blood pressure. Therefore, your healthcare provider will ensure your blood pressure is well-controlled before starting Fetzima. As you take Fetzima, your healthcare provider will closely monitor your blood pressure.

Seizures: There have been some reports of seizures with Fetzima. If you have a history of seizures, your healthcare provider may monitor your condition closely.

Missed Dose

If you accidentally forget your Fetzima dose, take it as soon as you remember. If it's already close to your next scheduled dose, then skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.

Find ways to help yourself remember to routinely keep your appointments and take your medication. If you miss too many doses, Fetzima might be less effective. Missing too many doses may also result in discontinuation (withdrawal) symptoms.

Overdose: What Happens If I Take Too Much Fetzima?

There is limited information available about Fetzima overdose. Study participants were able to tolerate a high daily dose of Fetzima at 360 milligrams (mg).

If you think that you're experiencing an overdose or life-threatening symptoms, however, seek immediate medical attention.

What Happens If I Overdose on Fetzima?

If you think you or someone else may have overdosed on Fetzima, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Fetzima, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly.

Do not take levomilnacipran with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid [Marplan®], phenelzine [Nardil®], selegiline [Eldepryl®], tranylcypromine [Parnate®]). Do not start taking levomilnacipran during the 2 weeks after you stop a MAO inhibitor. Wait 1 week after stopping levomilnacipran before you start taking a MAO inhibitor. If you take them together or do not wait the proper amount of time, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe seizures.

Levomilnacipran may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Levomilnacipran may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use levomilnacipran with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), linezolid (Zyvox®), lithium (Eskalith®, Lithobid®), methylene blue injection, tryptophan, St. John's wort, amphetamines, or some pain or migraine medicines (eg, rizatriptan, sumatriptan, tramadol, Frova®, Imitrex®, Maxalt®, Relpax®, Ultram®, Zomig®). Check with your doctor first before taking any other medicines with levomilnacipran.

This medicine may increase your risk for bleeding problems. Make sure your doctor knows if you are also taking other medicines that thin the blood, including aspirin, nonsteroidal antiinflammatory agents, also called NSAIDs (eg, diclofenac, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Voltaren®), or warfarin (Coumadin®, Jantoven®).

Do not stop taking this medicine without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely to decrease the chance of withdrawal effects. Some examples of withdrawal effects include agitation, breathing problems, chest pain, confusion, diarrhea, dizziness or lightheadedness, fast heartbeat, headaches, increased sweating, muscle pain, nausea, restlessness, runny nose, trouble sleeping, trembling or shaking, unusual tiredness or weakness, vision changes, or vomiting.

This medicine may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who are taking diuretic medicines, or those who have less fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have confusion, a headache, memory problems, trouble concentrating, weakness, or feel unsteady when standing.

This medicine may cause some people to become dizzy, drowsy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert.

Check with your doctor right away if you have decreased interest in sexual intercourse, delayed or inability to have an orgasm in women, inability to have or keep an erection in men, or loss in sexual ability, desire, drive, or performance. These could be symptoms of sexual dysfunction.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

What Are Reasons I Shouldn’t Take Fetzima?

Before taking Fetzima, talk with your healthcare provider if any of the following applies to you:

  • Severe allergic reaction: If you have a severe allergic reaction to Fetzima or its ingredients, this medication isn't a viable option for you.
  • Pregnancy: Fetzima might increase the pregnant parent's bleeding risk when giving birth. Newborns might also experience side effects that require hospitalizations and tube feeding when exposed to Fetzima during late pregnancy (e.g., third trimester). Untreated depression, however, also has certain risks. Reach out to your healthcare provider to discuss the benefits and risks of Fetzima during pregnancy. You can also enroll in a pregnancy exposure registry by visiting the National Pregnancy Registry for Antidepressants website or calling 844-405-6185.
  • Breastfeeding: Fetzima might be present in human breast milk. Fetzima doesn't seem to negatively affect milk production. However, Fetzima is an SNRI. Some nursing infants exposed to SNRIs through breast milk have become agitated or irritable, and have had trouble feeding and gaining weight. Therefore, Fetzima should be used with caution while breastfeeding. Contact your healthcare provider to discuss the benefits and harms of Fetzima while nursing.
  • Older adults over 65 years of age: Older adults tend to have more medical conditions when compared to younger adults. As a result, older adults might be more sensitive to Fetzima's side effects, such as low sodium blood levels. Therefore, Fetzima should be used with caution.
  • Children: Fetzima hasn't been studied in children.
  • Monoamine oxidase inhibitor (MAOI) use: Avoid taking Fetzima with MAOIs, such as the linezolid antibiotic or selegiline for Parkinson's disease (PD). It's recommended that you don't start Fetzima until 14 days after you stop an MAOI. If you're switching from Fetzima to an MAOI, on the other hand, you'll need to wait a minimum of seven days before taking an MAOI. Combining MAOIs and Fetzima raises serotonin to dangerous levels, increasing your serotonin syndrome risk. Serotonin syndrome is a rare but life-threatening side effect of Fetzima. Side effects may include seizures, sweating, and tremors.

What Other Medications Interact With Fetzima?

Also use caution when taking Fetzima with the following medications:

  • Alcohol: Fetzima is an extended-release (ER) capsule. Alcohol might result in a faster release of Fetzima in your body. This can increase your chances of side effects.
  • Blood thinners: Fetzima might increase your bleeding risk. As a result, be careful with other blood thinners, such as warfarin and aspirin.
  • Medications that raise serotonin levels: Fetzima can boost your serotonin levels. Taking other medicines that also have this effect will raise your serotonin levels and increase your risk of serotonin syndrome. An example of a serotonin-raising substance is the supplement Saint-John's-wort, which is available over the counter (OTC) and is sometimes used for depression.
  • Potent CYP3A4 inhibitors: CYP3A4 is a protein in the liver responsible for breaking down medications—like Fetzima. Taking a strong CYP3A4 inhibitor prevents the CYP3A4 protein from working as well. As a result, Fetzima will likely build up in the body, which increases your risk of side effects. An example of a potent CYP3A4 inhibitor is the ketoconazole antifungal.

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Fetzima.

And be sure to talk with your healthcare provider about any other medicines you take or plan to take, including nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

There are several medication options available to treat depression. For the most part, different antidepressants are similarly effective—with SNRIs being one of the go-to choices. The best antidepressant, however, will vary by individual and depend on several factors, including potential side effects, interactions, cost, and your preference.

Fetzima, however, is an SNRI. Therefore, the following SNRIs will be most similar to Fetzima:

Since these medications are all SNRIs, they're not typically taken together.

Frequently Asked Questions

  • Where is Fetzima available?

    Fetzima is available with a prescription from your healthcare provider. Your local retail pharmacy may carry this medication. If it doesn't have Fetzima in stock, the pharmacy staff will likely be able to order it for you.

  • How much does Fetzima cost?

    Fetzima doesn't have a generic product yet. Therefore, it might be costly without insurance coverage.

    If cost is a concern, one option is switching to another SNRI that has a generic version available. Fetzima's manufacturer also has a savings program. For eligibility questions, visit manufacturer AbbVie's website or the Fetzima website, or call 800-222-6885.

    Other potentially helpful resources include RxAssist, NeedyMeds, FundFinder, Simplefill, BenefitsCheckUp, Medicare Rights Center, State Pharmaceutical Assistance Programs (SPAPs), and Rx Outreach.

  • Will I need to take other medications in addition to Fetzima?

    The number of medications will vary by individual. Some people might take multiple medications for depression.

  • How long do I have to take Fetzima?

    In some people with depression, life-long treatment is necessary to prevent depression symptoms from coming back.

    If you have any questions about your treatment plan, speak with your healthcare provider before making any changes.

How Can I Stay Healthy While Taking Fetzima?

If you're taking Fetzima, chances are depression has been negatively affecting your quality of life. You may have tried different approaches or treatments.

While living with depression does have its challenges, there are ways to help improve your quality of life. Refer below for some general suggestions to help you manage depression.

  • Take depression-related medications as recommended by your healthcare provider.
  • Eat a healthy diet.
  • Regularly exercise.
  • Find ways to manage stress.
  • Make sure that you get enough sleep.
  • Consider support groups or mental health professionals to help you find coping strategies that change how you think, feel, react, or respond to living with bipolar or depression.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Fetzima label.

  2. National Institute of Mental Health. Major Depression.

  3. National Alliance on Mental Illness. Depression.

  4. National Alliance on Mental Illness. Levomilnacipran (Fetzima).

  5. National Alliance on Mental Illness. Bipolar disorder.

  6. ScienceDirect. CYP3A4.

  7. Gelenberg AJ, Freeman MP, Markowitz JC, et al. Practice guidelines for the treatment of patients with major depressive disorder. American Psychiatric Association. 2010.

  8. MedlinePlus. Desvenlafaxine.

  9. MedlinePlus. Duloxetine.

  10. Medlineplus. Milnacipran.

  11. MedlinePlus. Venlafaxine.

  12. Food and Drug Administration. Orange book—approved drugs with therapeutic equivalence evaluations.

By Ross Phan, PharmD, BCACP, BCGP, BCPS
Ross is a writer for Verywell with years of experience practicing pharmacy in various settings. She is also a board-certified clinical pharmacist and the founder of Off Script Consults.