Levomilnacipran

DEA Class;  Rx

Common Brand Names; Fetzima

Hypersensitivity

Nausea (17%)

Erectile dysfunction, dose-related (6-10%)

Constipation (9%)

Tachycardia (6%)

Urinary hesitation, dose-related (4-6%)

Palpitations (5%)

Vomiting (5%)

Hyperhidrosis (2%)

Increased heart rate (1%)

Increased blood pressure (1%)

Hot flush (1%)

Hypotension (1%)

Decreased appetite (1%)

Testicular pain

Ejaculation disorder

Takotsubo cardiomyopathy

All patients being treated with antidepressants should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of treatment and when increasing or decreasing the dose; consider changing therapeutic regimen, including possibly discontinuing therapy, in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors

SSRIs and SNRIs may impair platelet aggregation and increase the risk of bleeding events, ranging from ecchymoses, hematomas, epistaxis, petechiae, and GI hemorrhage to life-threatening hemorrhage; concomitant use of other drugs that inhibit platelets or anticoagulants may increase this risk; inform patients about risk of bleeding associated with concomitant use of drug and NSAIDs, aspirin, or other drugs that affect coagulation

Risk of mydriasis; may trigger angle closure attack in patients with angle-closure glaucoma with anatomically narrow angles without a patent iridectomy; pre- existing glaucoma is almost always open-angle glaucoma because angle-closure glaucoma, when diagnosed, can be treated definitively with iridectomy; open-angle glaucoma is not a risk factor for angle-closure glaucoma

Can affect urinary hesitation or retention; caution with obstructive urinary disorders and discontinue is symptoms present; the noradrenergic effect of the drug, can affect urethral resistance; if symptoms of urinary hesitation, urinary retention, or dysuria develop during treatment, consideration should be given to possibility that they might be drug-related, and discontinuation or other appropriate medical intervention should be considered

May activate mania/hypomania in patients with bipolar disorder; screen patients for bipolar disorder prior to initiating; use cautiously in patients with a history or family history of bipolar disorder, mania, or hypomania

Caution with seizure disorders; not systematically evaluated in patients with seizure disorder

There is pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy

There are no available data on presence of drug in human milk; however, racemic milnacipran is present in human milk