Fetzima (Levomilnacipran): Uses, Dosage, Side Effects, & Warnings

What Is Fetzima (Levomilnacipran)?

Fetzima is an antidepressant medication that belongs to the class of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs).¹ It works by affecting certain chemicals in the brain, specifically serotonin, and norepinephrine, which play roles in mood regulation. Fetzima is primarily used to treat Major Depressive Disorder (MDD) in adults. It’s important to note that Fetzima’s effectiveness, safety, and appropriate usage may vary among individuals, so it’s crucial to consult a healthcare professional for personalized guidance.

How Does Fetzima Work?

Fetzima works by adjusting certain chemicals in the brain that influence our mood. It helps keep more of these chemicals, like serotonin and norepinephrine, active for longer, which can lead to better feelings of happiness and motivation. This can help improve depression symptoms and make people feel better overall.²

How Is Fetzima Different from Effexor

Fetzima and Effexor are medications used to treat depression and belong to the same class of drugs called serotonin and norepinephrine reuptake inhibitors (SNRIs). They work by influencing chemicals in the brain that affect mood. However, Fetzima is specifically indicated for Major Depressive Disorder (MDD) in adults, while Effexor is approved for depression, anxiety, and other mental health conditions. It’s important to consult a healthcare professional to determine which medication may be more suitable based on an individual’s specific needs.

What Is Fetzima Used to Treat?

Fetzima is a medication that has been FDA-approved to treat major depressive disorder (MDD) in adults.¹ Being FDA-approved means that the U.S. Food and Drug Administration has evaluated the medication’s safety and effectiveness for a specific condition.

It’s important to note that sometimes healthcare providers may choose to prescribe Fetzima “off-label” for conditions or uses not specifically approved by the FDA. Off-label use is when a medication is prescribed for a purpose other than what it was initially approved for, based on the prescriber’s judgment that it could provide benefits in certain cases.

Fetzima Warnings & Precautions

When taking Fetzima, it’s vital to be aware of potential risks and heed precautions, as certain conditions may require medical attention. Angle-closure glaucoma, urinary issues, hypomania, and seizures are also concerns. Gradual dose reduction during discontinuation, monitoring for sexual dysfunction, and discussing any symptoms with a healthcare provider are essential steps to ensure the safe use of Fetzima.

Precautions for taking Fetzima include:¹

• Serotonin syndrome: The risk of serotonin syndrome increases when taken alone, and especially with other serotonergic drugs. Symptoms include mental changes, autonomic instability, and neuromuscular symptoms.
• Use during pregnancy and breastfeeding: The safety of Fetzima during pregnancy and breastfeeding hasn’t been established.
• Elevated blood pressure: Blood pressure should be measured before and during treatment, with caution exercised in patients with existing hypertension or heart conditions.
• Elevated heart rate: Heart rate should also be checked at medical visits, especially in patients with tachyarrhythmias or cardiac disease.
• Increased risk of bleeding: Fetzima use may raise the risk of bleeding, especially when used with drugs affecting coagulation.
• Angle-closure glaucoma: Fetzima might trigger angle-closure attacks in patients with narrow angles.
• Urinary hesitation or retention: The noradrenergic effects of Fetzima can potentially cause urinary issues.
• Activation of mania/hypomania: Patients with a history of bipolar disorder should be screened for symptoms of mania or hypomania.
• Seizures: Fetzima should be used cautiously in patients with a seizure disorder.
• Discontinuation syndrome: Symptoms like mood changes, dizziness, and insomnia may occur upon discontinuation. Gradual dose reduction is advised.
• Low sodium (hyponatremia): Low sodium levels (hyponatremia) can result from Fetzima use, especially in elderly patients or those taking diuretics.
• Sexual dysfunction: Fetzima may cause sexual dysfunction, with potential effects on libido and orgasm in both male and female patients.

Interactions With Fetzima

Fetzima has the potential to interact with several medications, substances, and herbs, which could lead to harmful effects. These interactions should be taken seriously and closely monitored. These interactions emphasize the importance of healthcare providers’ guidance and close monitoring when taking Fetzima to ensure safe and effective use.

5 substances you should avoid while taking Fetzima include:¹

• Monoamine oxidase inhibitors (MAOIs): Mixing Fetzima with MAOIs can make a condition called serotonin syndrome more likely. This is serious and the two shouldn’t be used together. Examples of MAOIs are selegiline and phenelzine.
• Other serotonergic drugs: Taking Fetzima along with other drugs that affect serotonin can also raise the chance of serotonin syndrome. This syndrome can have bad effects on your body, so if you use these drugs together, watch out for symptoms.
• Drugs that interfere with hemostasis: If you’re already using drugs that stop bleeding, taking Fetzima with them can increase the risk of bleeding. Fetzima can affect how your blood releases serotonin.
• Strong CYP3A4 inhibitors: CYP3A4 affects the strength of these medications when taken with Fetzima.
• Alcohol: Drinking alcohol with Fetzima can affect how both substances work in your body. It’s safer not to use them at the same time to avoid problems.

Can You Overdose on Fetzima?

While there is limited information about Fetzima overdose in humans, it’s essential to be cautious. In clinical studies, cases of taking up to 360 mg daily were reported, and fortunately, none were fatal. However, it’s important to seek medical attention immediately in case of an overdose. There’s no specific antidote for Fetzima overdose. Signs of an overdose might include severe dizziness, confusion, increased heart rate, high blood pressure, and agitation. If you suspect an overdose, getting help promptly is the best course of action to ensure your safety.¹

What Should You Do If You Take Too Much Fetzima?

If you take too much Fetzima, it’s crucial to seek help immediately. Contact a healthcare professional or a local poison control center, or go to the nearest emergency room. Share the information about the amount of Fetzima you took and when you took it. Prompt action is important to ensure proper medical attention and monitoring, as well as to prevent any potential complications or adverse effects.

Fetzima Dosages for FDA-Approved Treatment

Fetzima dosages can vary for each person and depend on factors like their specific condition, medical history, and how their body responds to the medication. The typical dosage range of Fetzima spans from 20 mg to 120 mg, with the medication available in various strengths.²

The dosing process aims to find the right balance between effectiveness and minimizing potential side effects. It’s important to follow the guidance of a healthcare provider when determining the appropriate dosage for an individual’s needs.

Fetzima Forms & Strengths

Fetzima comes in extended-release capsules with strengths of 20 mg, 40 mg, 80 mg, and 120 mg. The right choice depends on the patient’s age, the illness they have, and how serious it is. These capsules release the medicine slowly over time, which helps keep the effects steady and might mean fewer doses.

Doctors choose the form and strength based on things like the patient’s age, the illness they’re treating, and how bad it is. The capsules work within hours to days, and full effects might take a few weeks. It all depends on what the doctor thinks is best for the patient’s unique situation.

Fetzima is available in the following forms and strengths:¹

• 20 milligrams (mg) extended-release capsule
• 40 milligrams (mg) extended-release capsule
• 80 milligrams (mg) extended-release capsule
• 120 milligrams (mg) extended-release capsule

It’s important to take Fetzima exactly as prescribed by your healthcare provider. If you have any questions or concerns about how to take your medication, make sure to discuss them with your healthcare provider for proper guidance.

How Should I Take Fetzima?

To take Fetzima correctly, follow your doctor’s instructions closely. Usually, the recommended dose is 40 mg to 120 mg, taken once daily, with or without food. The maximum dose is 120 mg per day. Always swallow the capsules whole; don’t open, chew, or crush them.¹

If you have kidney issues, your dose might change. For severe renal impairment, the maximum dose is 40 mg once daily. For moderate renal impairment, it’s 80 mg once daily. Remember, following your doctor’s instructions precisely is crucial for the medicine to work properly and safely. If you have any questions about how, when, or with what to take Fetzima, always consult your doctor for clear guidance.

What Happens If I Miss a Dose of Fetzima?

If you miss a dose of Fetzima, take it as soon as you remember. However, if it’s close to the time for your next dose, skip the missed dose and continue with your regular schedule. It’s important not to take extra doses to catch up and not to stop taking Fetzima abruptly without consulting your healthcare provider. If you have any concerns about missed doses or changes in your medication, it’s best to discuss them with your doctor for proper guidance.

Side Effects of Fetzima

The common side effects of Fetzima involve nausea, constipation, sweating, abnormal heartbeat, erectile dysfunction, and vomiting. Some of these side effects might persist as long as you’re on the medication. Temporary effects, as your body adjusts, can include initial nausea or changes in sleep.²

In severe cases, immediate medical attention might be needed for signs like hallucinations, seizures, coma, or death. If you experience any concerning effects, promptly consult your doctor for guidance.

Common Side Effects of Fetzima

Common side effects of Fetzima include symptoms like nausea, digestive issues, sweating, abnormal heartbeat, erectile dysfunction, and vomiting. If you notice any unusual or severe symptoms while taking Fetzima, it’s important to consult your healthcare provider for guidance.

Common side effects of Fetzima include:¹

• Nausea
• Constipation
• Hyperhidrosis (increased sweating)
• Heart rate increase
• Vomiting
• Palpitations

Serious Side Effects of Fetzima

While taking Fetzima, it’s important to be aware of potentially serious side effects, including hypersensitivity reactions, the possibility of suicidal thoughts and behaviors in adolescents and young adults, serotonin syndrome, increased blood pressure and heart rate, urinary issues, activation of mania/hypomania, seizures, and sexual dysfunction. If you experience any severe symptoms related to these areas, seeking immediate medical attention is recommended.

Serious side effects of Fetzima may include:¹

• Serotonin syndrome (risk of too much serotonin)
• Hallucinations
• Angle-closure glaucoma (eye problem)
• Seizures
• Activation of mania/hypomania
• Hyponatremia (low sodium levels)
• Coma

All medications, including Fetzima, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Antidepressant Discontinuation

Antidepressant discontinuation syndrome, also known as antidepressant withdrawal, can occur when stopping serotonergic antidepressants like Fetzima, especially if done suddenly. Symptoms may include mood changes, agitation, dizziness, sensory disturbances, anxiety, confusion, headache, and more. While often self-limiting, severe symptoms have been reported.¹

It’s vital to monitor for these symptoms during discontinuation and to gradually reduce the dose whenever possible. If symptoms are intolerable, it’s recommended to resume the previous dose and then gradually decrease it over time. Immediate medical care is advised if severe symptoms occur.

Allergic Reactions to Fetzima

Allergic reactions to Fetzima are possible, and patients should inform their healthcare provider if they experience symptoms like rash, swelling, or difficulty breathing. People who are allergic to levomilnacipran, milnacipran HCl, or any ingredients in the medication should avoid Fetzima.

Additionally, Fetzima should not be taken alongside monoamine oxidase inhibitors (MAOIs) used for treating psychiatric disorders, as it can increase the risk of serotonin syndrome, a serious condition.

Allergic reactions to Fetzima may include:²

• Rash
• Hives
• Swelling
• Difficulty breathing
• Itching

If someone experiences these allergic reactions, it’s important to notify their healthcare provider immediately. In such cases, their healthcare provider can explore alternative medication options for their condition.

Fetzima Costs & Insurance Coverage

The cost of Fetzima can be as low as $10 for a 90- or 30-day prescription with the Fetzima Savings Program. This program is designed to help commercially insured patients save on their medication costs. Depending on eligibility, you could save up to $145 on each of your first 12 Fetzima prescriptions.³

It’s advised to talk to your healthcare provider about this program and consider a 90-day prescription to maximize savings. Check the program’s terms and conditions for any restrictions that may apply.

Questions to Ask Your Healthcare Provider About Fetzima (Levomilnacipran)

If you’re considering Fetzima as a treatment option for your depression or anxiety, it’s a good idea to have a conversation with your doctor, psychiatrist, and therapist. You might want to ask about the benefits and potential side effects of Fetzima, how it compares to other medications, and whether it’s suitable for your specific needs. If you’re considering changing prescribers or need a more convenient option, online psychiatry services could provide a valuable solution to ensure consistent and quality care.

Questions to ask your care team about Fetzima include:

• How long does it usually take for people to adjust to taking Fetzima?
• I’m already taking other anxiety/depression medications. Could this put me at risk for more severe symptoms?
• What’s the best dosage to minimize potential side effects?
• If I experience sexual side effects, when should I reach out to you?
• Are there any specific interactions I should watch out for, especially if I’m taking other medications?
• How often should I see my psychiatrist for check-ins while on Fetzima?
• Are there any lifestyle changes or habits that can complement the effects of Fetzima?
• How will Fetzima interact with my current therapy sessions? Should I let my therapist know about this medication?
• Are there any specific warning signs that I should be aware of while taking this medication?
• Are there any long-term effects of taking Fetzima that I should know about?
• Can I still drive and operate machinery safely while on Fetzima?
• How might my diet affect the effectiveness of Fetzima?
• If I decide to discontinue Fetzima, how should I go about it to minimize potential withdrawal symptoms?
• Are there any additional resources or support groups you recommend for people taking Fetzima?

In My Experience

In my experience, discussing topics like Fetzima with healthcare providers is vital for personalized mental health care. Every individual’s situation is unique, and these questions provide a solid starting point.

Collaborating with professionals, combining medication with therapy, and embracing lifestyle changes can lead to positive outcomes for anxiety and depression. My advice is to maintain open communication with your care team, ask questions, and adhere to their guidance. Remember, seeking support is a positive step towards achieving better mental well-being.