F and E: hyponatremia (in association with syndrome of inappropriate antidiuretic hormone [SIADH])
Misc: SEROTONIN SYNDROME
* CAPITALS indicate life-threatening. Underline indicate most frequent.
Concurrent use with MAO inhibitors used for psychiatric disorders may result in serious, potentially fatal reactions; wait at least 14 days following discontinuation of MAO inhibitor before initiation of levomilnacipran. Wait at least 7 days after discontinuing levomilnacipran before initiation of MAO inhibitor.
Concurrent use with MAO-inhibitor like drugs, such as linezolid or methylene blue, may ↑ risk of serotonin syndrome; concurrent use contraindicated; do not start therapy in patients receiving linezolid or methylene blue; if linezolid or methylene blue need to be started in a patient receiving levomilnacipran, immediately discontinue levomilnacipran and monitor for signs/symptoms of serotonin syndrome for 2 wk or until 24 hr after last dose of linezolid or methylene blue, whichever comes first (may resume levomilnacipran therapy 24 hr after last dose of linezolid or methylene blue).
Drugs that affect serotonergic neurotransmitter systems, including tricyclic antidepressants, SNRIs, fentanyl, buspirone, tramadol, amphetamines, and triptans ↑ risk of serotonin syndrome.
Concurrent use of NSAIDs, aspirin, warfarin or otherdrugs that affect coagulation may ↑ the risk of bleeding.
Concurrent use of other medications that may ↑ BP may ↑ risk of hypertension.
Concurrent use with alcohol may cause a rapid release of drug and should be avoided.
Concurrent use with other CNS-active medications, especially other NSRIs.
Concurrent use with St. John's wort or tryptophan may ↑ the risk of serotinin syndrome; also ↑ risk of coronary vasoconstriction and hypertension.
PO (Adults) 20 mg once daily for two days, then increase to 40 mg once daily, may then be ↑ by 40 mg every two or more days; may be ↑ up to 120 mg/day; Concurrent use of CYP3A4 inhibitors (including ketoconazole, clarithromycin, ritonavir)–not to exceed 80 mg/day.
Renal Impairment PO (Adults) CCr 30–59 mL/min–not to exceed 80 mg/day; CCr 15–29 mL/min–not to exceed 40 mg/day.
PO Administer daily without regard to food. Swallow capsule whole; do not open, crush, or chew.
Instruct patient to take levomilnacipran as directed at the same time each day. Take missed doses as soon as possible unless time for next dose; do not double dose. Do not stop abruptly; must be decreased gradually. Abrupt discontinuation may cause dysphoric mood, irritability, agitation, dizziness, paresthesia, electric shock sensation, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus and seizures. Advise patient to read Medication Guide prior to therapy and with each Rx refill in case of changes.
May cause drowsiness and may affect ability to make decisions or react quickly. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient, family, and caregivers to look for activation of mania/hypomania and suicidality, especially during early therapy or dose changes. Notify health care professional immediately if thoughts about suicide or dying, attempts to commit suicide; new or worse depression or anxiety; agitation or restlessness; panic attacks; insomnia; new or worse irritability; aggressiveness; acting on dangerous impulses, mania, or other changes in mood or behavior or if symptoms of serotonin syndrome occur.
Caution patient of the risk or serotonin syndrome (agitation, hallucinations, changes in mental status, muscle twitching, fast heartbeat, high or low BP, sweating or fever, nausea or vomiting, diarrhea, muscle stiffness or tightness), especially when taking triptans, tramadol, tryptophan supplements and other serotonergic or antipsychotic agents.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to avoid concurrent use of Rx, OTC, and herbal products, especially NSAIDs, aspirin, and warfarin, without consulting health care professional; may increase bleeding.
Instruct patient to notify health care professional if signs of hyponatremia (headache, difficulty concentrating, memory impairment, confusion, weakness, unsteadiness) occur.
Advise patient to avoid taking alcohol during levomilnacipran therapy.
Instruct patient to notify health care professional if pregnancy is planned or suspected and to avoid breast feeding during therapy.
Encourage patient to maintain routine follow-up visits with health care provider to determine effectiveness.
Increased sense of well-being
Renewed interest in surroundings. Need for therapy should be periodically reassessed.
levomilnacipran is a sample topic from the Davis's Drug Guide.
Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Complete Product Information.