Levomilnacipran is a generic prescription drug approved to treat depression. It’s also available as the brand-name drug Fetzima. Levomilnacipran comes as an extended-release oral capsule.

Specifically, levomilnacipran is prescribed to treat major depressive disorder (also referred to as depression) in adults.

To learn more about levomilnacipran’s uses, see the “Uses for levomilnacipran” section.

Levomilnacipran basics

Levomilnacipran is a generic medication that’s also available as the brand-name drug Fetzima. It belongs to a group of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). Generic drugs are considered as safe and effective as the brand-name drug they’re based on, but they usually cost less.

Levomilnacipran has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). For details, see the “Precautions” section.

Levomilnacipran is prescribed to treat major depressive disorder (also referred to as depression) in adults.

Depression is a mental health condition that affects how a person feels, thinks, and acts. It’s often marked by ongoing sadness and a lack of interest in things they once enjoyed. Depression may cause symptoms such as fatigue, changes in eating or sleeping habits, and irritability.

It’s not fully known how levomilnacipran works to treat depression. However, it’s thought that the drug increases certain chemical levels in the brain, which may help ease symptoms of depression.

Like most drugs, levomilnacipran may cause mild to serious side effects. The following lists contain some of the more common side effects this drug may cause, but they don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

  • your age
  • other health conditions you have
  • other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of levomilnacipran. They can also suggest ways to help reduce side effects.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medications safer for everyone by giving doctors and researchers more information about how the drug works in real life. If you develop a side effect while taking levomilnacipran and want to tell the FDA about it, visit MedWatch or call 800-FDA-1088.

Mild side effects

Here’s a list of some of the mild side effects that levomilnacipran can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read the drug’s prescribing information.

Mild side effects of levomilnacipran that have been reported include:

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from levomilnacipran can occur, but they aren’t common. If you have serious side effects from this medication, call your doctor right away. If you think you’re having a medical emergency, call 911 or your local emergency number.

Serious side effects of levomilnacipran that have been reported include:

For more information about side effects related to boxed warnings, see the “Precautions” section.

Allergic reaction

For some people, levomilnacipran can cause an allergic reaction. But this side effect wasn’t reported in the drug’s studies.

In general, symptoms of an allergic reaction can be mild or serious.

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms and can determine whether you should continue levomilnacipran treatment.

If you have symptoms of a severe allergic reaction, such as swelling or difficulty breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to levomilnacipran, they may have you switch to a different treatment.

The levomilnacipran dosage your doctor prescribes will depend on several factors. These include:

  • severity of the condition you’re taking levomilnacipran to treat
  • other medical conditions you may have
  • other medications you’re taking

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. They’ll determine the best dosage to fit your needs.

Form and strengths

Levomilnacipran comes as an extended-release oral capsule. (“Extended release” means that the drug is slowly released into your body over a period of time.)

Levomilnacipran is available in the following strengths:

  • 20 milligrams (mg)
  • 40 mg
  • 80 mg
  • 120 mg

Recommended dosages

The following information outlines the typical recommended dosages of levomilnacipran. However, your doctor will prescribe the dosage that’s right for you.

Dosage for depression

For the treatment of major depressive disorder, your doctor will likely start you out with a dosage of 20 mg once per day for the first 2 days. After that, they may increase your dosage of levomilnacipran to 40 mg once per day.

If needed, your doctor may gradually raise your dose every few days until they find the amount that works best for your condition. The usual ongoing dosage ranges from 40 mg to 120 mg once per day.

Note: Your doctor may give you a different dosage depending on certain factors. For instance, if you have kidney problems, your doctor may prescribe a lower maximum dose. For moderate kidney disease, the highest recommended dose is 80 mg per day. For severe kidney disease, it’s 40 mg per day.

If you have questions about the dosage that’s right for you, talk with your doctor

About taking levomilnacipran

The following are some common questions about taking levomilnacipran.

  • Can levomilnacipran be chewed, crushed, or split? No, you should not chew, crush, or split levomilnacipran capsules. You should swallow them whole. If you have difficulty doing so, you can get tips on how to swallow pills, or ask your doctor or pharmacist for advice.
  • Should I take levomilnacipran with food? You can take levomilnacipran with or without food.
  • Is there a best time of day to take levomilnacipran? You can take levomilnacipran at any time of day, but it’s best to take it on a consistent schedule. This helps keep a steady level of the drug in your body, which helps it to work effectively.
  • What if I miss a dose of levomilnacipran? If you miss a dose of levomilnacipran, take it as soon as you remember. But if it’s almost time to take your next dose, skip the missed dose and take the next dose at its usual time. You should not take two doses at once to make up for a missed dose. Doing so could increase your risk of side effects.
  • Will I need to take levomilnacipran long term? Levomilnacipran may be taken as a long-term treatment. If you and your doctor determine that it’s safe and effective for your condition, you’ll likely take it long term.
  • How long does levomilnacipran take to work? Levomilnacipran begins to work after your first dose, but it may take several weeks for the drug to reduce the symptoms of your condition. If you have questions about what to expect from treatment with this medication, talk with your doctor.

Levomilnacipran can interact with several other medications and certain supplements. But the drug is not known to interact with foods.

Before taking levomilnacipran, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, or supplements you use. Sharing this information can help you avoid potential interactions.

Interactions with medications and supplements

The following table highlights medications and supplements that can interact with levomilnacipran. This list does not contain all drugs that may interact with levomilnacipran. If you have questions about interactions that may affect you, ask your doctor or pharmacist.

Medications that can interact with levomilnacipran• other SNRIs, such as duloxetine (Cymbalta) and venlafaxine (Effexor XR)

• selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft)

• tricyclic antidepressants (TCAs), such as amitriptyline and imipramine

• monoamine oxidase inhibitors (MAOIs), such as phenelzine (Nardil) and linezolid (Zyvox)

• triptans, such as sumatriptan (Imitrex, Tosymra, others) and rizatriptan (Maxalt, Maxalt-MLT)

• opioids, such as oxycodone (Oxycontin, Roxicodone, others) and hydrocodone (Hysingla ER)

• amphetamines, such as amphetamine/dextroamphetamine (Adderall, Adderall XR) and dextroamphetamine (Dexedrine, Xelstrym)

• nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen (Advil, Aleve)

• certain antifungals, such as itraconazole (Sporanox, Tolsura) and ketoconazole

• lithium (Lithobid)

• buspirone

• warfarin (Jantoven)

• clarithromycin
Supplements that can interact with levomilnacipran• St. John’s wort

Levomilnacipran and alcohol

It may not be safe to consume alcohol while taking levomilnacipran. This is because alcohol can cause the drug to be released too quickly into your body, which may increase your risk of side effects.

If you have questions about the safety of drinking alcohol during levomilnacipran treatment, talk with your doctor or pharmacist.

Whether you have health insurance or not, cost may be a factor when you’re considering levomilnacipran. What you’ll pay for this medication may depend on several things, such as your treatment plan and the pharmacy you use.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist.

The following is important information to consider and discuss with your doctor or pharmacist before starting levomilnacipran treatment.

Pregnancy and levomilnacipran

There are risks to taking levomilnacipran during pregnancy. But there are also risks with having unmanaged depression while pregnant. (Levomilnacipran is prescribed to treat depression.)

Specifically, taking levomilnacipran in the month before delivery could raise your risk of heavy bleeding after childbirth. Taking levomilnacipran during the third trimester may also affect a newborn. Possible issues include tremors and difficulties with breathing, feeding, or managing body temperature.

If you’re planning a pregnancy or can become pregnant, talk with your doctor about potential treatments for depression during pregnancy. Together, you can consider the risks and benefits of your treatment options and decide whether you should take levomilnacipran during pregnancy.

If you take levomilnacipran while you’re pregnant, consider signing up for the National Pregnancy Registry for Antidepressants. This registry collects information about the safety of levomilnacipran when taken during pregnancy. You can learn more by calling 844-405-6185, visiting the registry website, or talking with your doctor.

Levomilnacipran and breastfeeding

It’s not known whether levomilnacipran should be taken while breastfeeding. The drug may pass into breast milk and cause side effects in a child who is breastfed. Examples include inadequate weight gain, difficulty feeding, and irritability.

If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this drug.

This section describes the warnings and precautions for levomilnacipran.

FDA warning: Risk of suicidal thoughts and actions

Levomilnacipran has a boxed warning. This is the most serious warning from the FDA about drug effects that may be dangerous.

Levomilnacipran may increase the risk of suicidal thoughts and actions in people ages 24 years and younger. The risk of this side effect may be highest during the first several months of treatment and shortly after any dosage changes.

This side effect wasn’t reported in studies of levomilnacipran but is a risk of antidepressants. (Levomilnacipran is a type of antidepressant drug.)

Your doctor may advise you, family members, and close friends to watch for the following symptoms while you’re taking levomilnacipran:

Tell your doctor right away if you have any unusual changes in mood, behavior, or thoughts while taking levomilnacipran. They may change your treatment plan or prescribe a drug other than levomilnacipran for your condition.

Other precautions

Before starting levomilnacipran, discuss your health history with your doctor. This medication may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:

Note: For more information about the potential negative effects of levomilnacipran, see the “Side effects of levomilnacipran” section.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

There haven’t been studies on whether levomilnacipran can cause drug dependence. (This means your body gets used to a drug and needs it for you to function as usual.)

However, the manufacturer of levomilnacipran recommends against suddenly stopping the drug. This is because doing so may cause withdrawal symptoms. These are uncomfortable side effects that can happen if you stop taking a drug your body has become used to.

Possible withdrawal symptoms that may occur after suddenly stopping levomilnacipran may include:

  • irritability or agitation
  • dizziness
  • confusion
  • headache
  • shifts in mood
  • difficulty sleeping
  • seizures

If you and your doctor decide you’ll stop levomilnacipran, your doctor will create a plan to gradually lower your dose. This helps reduce the risk of withdrawal symptoms.

Other drugs are available that can treat depression. If you’d like to explore an alternative to levomilnacipran, talk with your doctor. They can tell you about other medications that might work well for you.

The following drugs are alternatives to levomilnacipran:

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.