Fetzima (Levomilnacipran) for Major Depressive Disorder

Fetzima (levomilnacipran) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for treating major depressive disorder in adults.

How Fetzima Works and How It’s Taken

Fetzima is a type of medication called a serotonin and norepinephrine reuptake inhibitor (SNRI).

It works by blocking the reuptake, or recycling, of serotonin and norepinephrine in the brain. The exact way it improves depression is not fully known. In major depressive disorder, this may help improve mood by increasing signals from these brain chemicals.

Healthcare providers prescribe Fetzima when an adult needs prescription treatment for major depressive disorder.

Fetzima is given as an extended-release capsule by mouth, typically once daily at about the same time each day. It can be taken with or without food. Fetzima capsules should be swallowed whole.

They should not be opened, chewed, or crushed.

Typical Dosing for Major Depressive Disorder

The recommended starting dose of Fetzima for major depressive disorder is 20 milligrams once daily for two days, then 40 milligrams once daily.

For people who respond to treatment, the recommended maintenance dose is 40 milligrams to 120 milligrams once daily.

Healthcare providers may raise the dose by 40 milligrams at intervals of two or more days based on response and tolerability. The maximum recommended dose is 120 milligrams once daily. Healthcare providers may lower the dose in people with kidney problems, and treatment should usually be stopped gradually rather than all at once.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Fetzima Side Effects

In clinical studies of adults taking Fetzima for major depressive disorder, the most common side effects occurred in about 5 percent to 17 percent of people. In these studies, some side effects also led people to stop treatment, most often because of nausea.

Nausea
Constipation
Sweating more than usual
Increased heart rate
Erectile dysfunction (trouble getting or keeping an erection)
Ejaculation problems (delayed ejaculation or inability to ejaculate)
Vomiting
Palpitations (fast or irregular heartbeat)
Tachycardia (abnormally fast heart rate)

Serious Side Effects and Warnings

Fetzima can cause serious side effects, some of which may require immediate medical attention. These include:

Suicidal thoughts and behaviors — The risk is higher in people ages 24 and younger, especially early in treatment or when the dose changes.
Serotonin syndrome — This potentially life-threatening reaction can cause agitation, confusion, sweating, fever, fast heartbeat, or muscle stiffness.
Increased blood pressure — Blood pressure may rise during treatment.
Increased heart rate — Heart rate may rise during treatment.
Increased risk of bleeding — The risk may be higher if you also take medicines like aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or blood thinners.
Angle-closure glaucoma — A sudden increase in eye pressure can cause eye pain, vision changes, or redness.
Urinary hesitation or urinary retention — These can cause trouble starting urination or not being able to empty your bladder.
Mania or hypomania — Unusually high energy, racing thoughts, or risky behavior can occur.
Seizures — Convulsions can occur.
Discontinuation syndrome — Symptoms can happen if the medicine is stopped suddenly.
Hyponatremia (low sodium levels) — This can cause headache, confusion, weakness, or severe symptoms in some cases.
Sexual dysfunction — Changes in sexual desire or sexual response can occur.

Get medical help right away if you think you are having a serious reaction.

How To Save on Fetzima

AbbVie, the manufacturer of Fetzima, offers the Fetzima Savings Program. Eligible people with commercial insurance may pay as little as $10 for a 30- or 90-day prescription. To learn more, visit the website or call 855-439-2801.

Maximum savings limits apply, and the offer is not valid for people enrolled in Medicare, Medicaid, or other federal or state programs.

What To Know Before Taking Fetzima

Before starting Fetzima, your healthcare provider will check for a personal or family history of bipolar disorder, mania, or hypomania. Your healthcare provider should also check your blood pressure and heart rate before you start Fetzima and during treatment. Tell your healthcare provider if you have high blood pressure, heart problems, a fast heartbeat, or a history of stroke.

Tell your healthcare provider if you have any allergies to levomilnacipran, milnacipran HCl, or any ingredients in Fetzima.

Tell your healthcare provider about all medicines you take, including prescription drugs, over-the-counter medicines, and supplements.

Do not drink alcohol while taking Fetzima. Alcohol may affect how the extended-release capsule releases the medicine.

Do not take Fetzima if you are allergic to levomilnacipran, milnacipran HCl, or any of its ingredients, or if you take a monoamine oxidase inhibitor (MAOI), including linezolid or intravenous methylene blue, or have taken an MAOI within the last 14 days. Do not start an MAOI within seven days of stopping Fetzima.

If you miss a dose, take it when you remember. If it is almost time for your next dose, skip the missed dose. Do not take two doses at the same time.

If you are pregnant, planning to become pregnant, or breastfeeding while taking Fetzima, talk with your healthcare provider about the risks and benefits. Fetzima may raise the risk of bleeding after delivery and may cause problems in newborns if taken late in pregnancy. These can include breathing, feeding, temperature control, or withdrawal-like symptoms.

If you breastfeed while taking Fetzima, call your healthcare provider if your baby is very sleepy or fussy, or is not feeding or gaining weight well.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Fetzima?

In three eight-week studies of adults with major depressive disorder, levomilnacipran worked better than placebo (an inactive treatment). People taking levomilnacipran had greater improvement in depression symptoms and daily functioning. The studies tested doses from 40 milligrams to 120 milligrams once daily.

A longer study also looked at relapse. Relapse means depression symptoms come back. People who responded after 20 weeks of open-label treatment were then placed into a double-blind phase.

People who stayed on levomilnacipran had a longer time to relapse than people switched to placebo.

How long does Fetzima take to work for major depressive disorder?

The studies showing benefit in major depressive disorder lasted eight weeks, and a maintenance study followed people for 20 weeks before the relapse phase. The study information does not give an exact number of days or weeks when an individual person should expect to feel improvement.

Can Fetzima be used with other medicines for major depressive disorder?

Fetzima should not be used with MAOIs, and it should not be started within 14 days of stopping an MAOI used for psychiatric treatment. After stopping Fetzima, at least seven days should pass before starting an MAOI. Using Fetzima with other serotonergic medicines can raise the risk of serotonin syndrome, and using it with strong CYP3A4 inhibitors means the dose should not exceed 80 milligrams once daily.

What tests or monitoring are needed with Fetzima for major depressive disorder?

Blood pressure and heart rate should be measured before starting Fetzima and checked periodically during treatment. Before starting treatment, people should also be screened for a personal or family history of bipolar disorder, mania, or hypomania. If treatment is being stopped, the dose should usually be reduced gradually, with monitoring for discontinuation symptoms.