Fetzima is a brand-name prescription drug. It's used to treat major depressive disorder (MDD) in adults. This condition is also called depression.

Fetzima contains the drug levomilnacipran, which belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs work by increasing levels of serotonin and norepinephrine (certain brain chemicals) in your body. This helps improve symptoms of MDD.

Fetzima comes as extended-release capsules that are taken by mouth once daily. It's available in the following strengths: 20 mg, 40 mg, 80 mg, and 120 mg.

Effectiveness

In three different clinical studies, people's depression symptoms were improved more with Fetzima treatment than with a placebo (treatment with no active drug).

In the studies, people's depression symptoms were scored using a test called Montgomery-Asberg Depression Rating Scale (MADRS).

This test evaluates people's moods (such as sadness), feelings of discomfort, quality of sleep, appetite level, ability to concentrate, and motivation to do certain activities. The test also looks at whether or not people are having thoughts of suicide. A lower MADRS score indicates fewer depression symptoms than a higher score does.

Over 8 weeks of treatment, on average, Fetzima lowered people's MADRS scores by 3.1 to 4.9 points more than the placebo did.

Fetzima is available only as a brand-name medication. It's not currently available in generic form.

Fetzima contains the active drug levomilnacipran. This drug belongs to a class of antidepressant drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs).

Fetzima can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Fetzima. These lists do not include all possible side effects.

For more information on the possible side effects of Fetzima, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs they have approved. If you would like to report to the FDA a side effect you've had with Fetzima, you can do so through MedWatch.

More common side effects

The more common side effects of Fetzima can include:

  • nausea
  • constipation
  • vomiting
  • excessive sweating
  • erectile dysfunction (inability to have or keep an erection)
  • decreased appetite
  • tachycardia (fast heart rate)
  • palpitations (feeling your heart flutter or skip a beat)

Most of these side effects may go away within a few days or a couple of weeks. If they're more severe or don't go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Fetzima aren't common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency.

Serious side effects and their symptoms can include the following:

  • Serotonin syndrome, which is a buildup of serotonin in your body that can occur with many antidepressants (including Fetzima). Symptoms can include:
    • changes in your mental status
    • hallucinations
    • delirium
    • sweating or feeling flushed
    • seizures
  • Increased blood pressure. Symptoms can include:
    • severe headache
    • vision problems
    • chest pain
    • trouble breathing
  • Abnormal bleeding. Symptoms can include:
    • bruising more often than usual
    • nosebleeds
    • cuts that take longer than usual to heal
    • stool that appears pink or black (may look like it has coffee grounds in it)
    • urine that appears pink or red
  • Trouble urinating. Symptoms can include:
  • Low sodium level in your blood. Symptoms include:
    • headache
    • trouble concentrating
    • memory problems
    • confusion
    • feeling weak or unsteady
    • fainting
    • seizures
    • coma
  • Severe allergic reaction, which is discussed in "Side effect details" below.
  • Suicidal thoughts and behaviors.* If you have thoughts of suicide, or any of the symptoms listed below, call your doctor right away. Symptoms can include:
    • changes in behavior
    • anxiety
    • panic attacks
    • insomnia (trouble sleeping)
    • irritability
    • hostility
    • being aggressive
    • acting on impulses
    • feeling restless

* Fetzima has a boxed warning from the FDA regarding the risk of suicidal thoughts and behaviors. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.
  • If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here's some detail on several of the side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Fetzima. It's not known for sure how many people taking Fetzima have allergic reactions to the drug. Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Fetzima. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency.

Anger

It's possible to have increased anger or agitation while you're taking Fetzima. In clinical studies, less than 2% of people who took the drug had feelings of anger, agitation, or aggression.

No one knows exactly why this side effect occurs. But antidepressants, including Fetzima, work by changing the way certain chemicals (such as serotonin and norepinephrine) are absorbed in your brain. By changing the way these chemicals are absorbed, certain changes in behavior (such as feeling angry) can occur.

If you have increased feelings of anger, agitation, or aggression while you're taking Fetzima, talk with your doctor right away. These feelings may indicate that the medication isn't working or even that it's making your depression worse. Your doctor can recommend changes to your treatment plan to help you feel better.

Sweating

Increased sweating is a possible side effect of Fetzima. In clinical studies, 9% of people who took Fetzima had excessive sweating. Of people taking a placebo (treatment with no active drug), 2% had excessive sweating. It's not known for sure why antidepressants, including Fetzima, can cause increased sweating.

If you have concerns about increased sweating with Fetzima treatment, talk with your doctor. They can recommend ways to help reduce this side effect.

Nausea

Nausea is a common side effect of Fetzima. In clinical studies, 17% of people who took Fetzima had nausea. In comparison, 6% of people who took a placebo (treatment with no active drug) had nausea. About 1.5% of people stopped treatment with Fetzima because of this side effect.

Nausea should go away after a few weeks of using this drug. You may feel less nauseous if you eat smaller meals rather than larger ones during treatment.

While taking Fetzima, if you have nausea that doesn't improve after a few weeks, talk with your doctor. They can recommend ways to help improve your nausea.

Constipation

You may have constipation while you're taking Fetzima. In clinical studies, 9% of people who took Fetzima had constipation. Of those taking a placebo (treatment with no active drug), 3% had constipation.

This side effect should go away after a few weeks of treatment. It may get better if you drink more fluids, eat foods that are high in fiber, and exercise regularly.

If you have constipation that doesn't improve after a few weeks, talk with your doctor. They can recommend ways to help reduce this side effect.

Dizziness

It's possible to feel dizzy, or even faint, while you're taking Fetzima. While it's not known for sure why Fetzima can cause dizziness, this condition can be related to other side effects of Fetzima. You may feel dizzy if you have low blood pressure, which is a condition that Fetzima may cause.

You may also feel dizzy if you have a serious condition called serotonin syndrome, which may be caused by Fetzima. With this condition, your body has a buildup of serotonin. Symptoms of serotonin syndrome include:

  • changes in your mental status, such as feeling confused or delirious
  • dangerously high fever
  • dangerously high blood pressure
  • dizziness

If you feel dizzy, or you have any other symptoms of serotonin syndrome, call your doctor right away. They can recommend if you need medical attention or treatment.

Weight gain or weight loss (not a side effect)

Fetzima doesn't usually cause changes in weight, such as weight gain or weight loss. However, taking medication for depression can affect your appetite, which could lead to changes in your weight.

People with depression sometimes have either no appetite or an increased appetite. When you take medication for depression, your appetite can change because your depression is being treated. Because of this, taking Fetzima can lead to weight gain or weight loss in some people.

If you're concerned about changes in your weight during Fetzima treatment, talk with your doctor.

Side effects in children

Fetzima is not approved for use in children (under 18 years of age).

However, Fetzima can cause an increased risk of suicidal thoughts and behaviors in children. See the "Fetzima side effects" section above for more information.

Fetzima is approved to treat major depressive disorder (MDD), also called depression, in adults. Fetzima isn't approved to treat anxiety, but sometimes it's used off-label for this condition. Off-label use is when a drug that's approved to treat one condition is used to treat a different condition.

However, using Fetzima may actually increase anxiety in some people. Typically, when you start taking an antidepressant in the same class of drugs as Fetzima, your anxiety can increase in the first couple weeks of treatment. After this, your anxiety usually gets better overall.

What is anxiety?

Anxiety is a normal response that most people have to stressful situations. Sometimes, symptoms of anxiety become severe and interfere with your daily activities. When this happens, normal feelings of anxiety turn into an anxiety disorder.

Symptoms of an anxiety disorder can include excessive worrying, feeling agitated or irritable, or having trouble concentrating. With an anxiety disorder, you may feel like avoiding social situations.

How Fetzima may cause anxiety

Fetzima belongs to a class of antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRIs). These antidepressants work by stopping the breakdown of certain chemicals (serotonin and norepinephrine) in your brain.

This results in higher amounts of these chemicals, which can improve your mood and reduce feelings of depression. But because the levels of these chemicals are being altered, you can sometimes have other changes in your mood, such as anxiety.

What this means for you

If you have increased anxiety while you're taking Fetzima, it could mean that Fetzima isn't working for you. During clinical studies, people who have the following symptoms while taking Fetzima have had worsening of their depression and thoughts of suicide. These symptoms include:

  • increased anxiety
  • agitation
  • panic attacks
  • lack of sleep
  • anger
  • restlessness
  • lack of impulse control

If you experience any of these symptoms, call your doctor right away. They may recommend that you use a medication other than Fetzima to treat your depression.

Don't stop taking Fetzima without talking with your doctor first. Stopping this drug abruptly may cause severe withdrawal symptoms, including feelings of anxiety. If your doctor recommends that you stop taking Fetzima, they will help you safely taper off of the drug. See the section below called "Fetzima withdrawal" for more details on stopping Fetzima treatment.

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

  • the severity of the condition you're using Fetzima to treat
  • your age
  • other medical conditions you may have

Typically, your doctor will start you on a low dosage. Then they'll adjust it over time to reach the amount that's right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

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

Drug forms and strengths

Fetzima is available as an extended-release capsule. It's taken by mouth once daily, with or without food. Fetzima is available in four strengths: 20 mg, 40 mg, 80 mg, and 120 mg.

The maximum recommended daily dosage of Fetzima is 120 mg.

Dosage for depression

The typical dosage of Fetzima for major depressive disorder (MDD), also called depression, is as follows:

  • The starting dosage is 20 mg taken by mouth once daily for 2 days.
  • After that, your doctor will increase your dosage to 40 mg taken by mouth once daily.
  • Your doctor may continue to increase your dose by 40 mg every 2 days until you reach the maximum dosage, which is 120 mg daily.

Fetzima is usually taken for several months or longer depending on your depression symptoms. Your doctor will monitor your symptoms every few months to see if you still need to take Fetzima.

What if I miss a dose?

If you miss a dose of Fetzima, take the missed dose as soon as you remember. If it's almost time for your next dose, just skip the missed dose and take your next scheduled dose instead. Never take more than one dose of Fetzima at a time. Doing so can increase your risk of serious side effects.

To help make sure that you don't miss a dose, try setting a reminder on your phone. A medication timer may be useful, too.

Will I need to use this drug long term?

Fetzima is usually taken for several months or longer depending on your depression symptoms. Your doctor will monitor your symptoms every few months to see if you still need to take Fetzima.

If you and your doctor decide that Fetzima is safe and effective for you, you'll likely take it long term.

The Food and Drug Administration (FDA) approves prescription drugs such as Fetzima to treat certain conditions. Fetzima may also be used off-label for other conditions. Off-label use is when a drug that's approved to treat one condition is used to treat a different condition.

Fetzima for depression

Fetzima is FDA-approved to treat major depressive disorder (MDD) in adults. MDD is also called depression. This mood disorder can cause symptoms that can interfere with your daily life. These symptoms can include:

  • intense feelings of sadness
  • emptiness
  • lack of motivation or interest
  • anger for extended periods of time

It's not known exactly why depression only affects some people. But there are several factors that can increase your risk of developing depression. These include:

  • your genetic makeup
  • past emotional or physical trauma
  • your brain structure
  • past or current recreational drug use
  • having certain medical conditions

Fetzima belongs to a class of antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRIs). These antidepressants work by stopping the breakdown of certain chemicals (serotonin and norepinephrine) in your brain. This results in higher amounts of these chemicals, which can improve your mood and reduce feelings of depression.

Effectiveness of Fetzima for depression

In three different clinical studies, people's depression symptoms were improved more with Fetzima treatment than with a placebo (treatment with no active drug).

In the studies, people's depression symptoms were scored using a test called Montgomery-Asberg Depression Rating Scale (MADRS). This test evaluates people's moods (such as sadness), feelings of discomfort, quality of sleep, appetite level, ability to concentrate, and motivation to do certain activities. The test also looks at whether or not people are having thoughts of suicide. A lower MADRS score indicates fewer depression symptoms than a higher score indicates.

Over 8 weeks of treatment, on average, Fetzima lowered people's MADRS scores by 3.1 to 4.9 points more than the placebo did.

Fetzima for other conditions

In addition to the use listed above, Fetzima may be used off-label. Off-label drug use is when a drug that's approved for one use is used for a different one that's not approved. And you may wonder if Fetzima is used for certain other conditions.

Fetzima for anxiety (off-label use)

Fetzima isn't approved to treat anxiety, but sometimes it's used off-label for this condition. Fetzima belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs are recommended as a first-choice treatment option for generalized anxiety disorder by the Anxiety and Depression Association of America.

For information about the symptoms of anxiety and how Fetzima works to treat it, see the section "Fetzima and anxiety" above.

Fetzima for fibromyalgia (not an appropriate use)

Fetzima isn't approved to treat fibromyalgia. The effectiveness and safety of Fetzima to treat this condition hasn't been shown in clinical studies.

With fibromyalgia, you have widespread pain in your muscles. This pain can affect your energy levels, quality of sleep, memory, and moods.

Fetzima belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). Some studies have shown that two other SNRIs, duloxetine (Cymbalta, Drizalma Sprinkle) and milnacipran (Savella), can help reduce pain caused by fibromyalgia. Levomilnacipran, the active drug in Fetzima, is very similar to milnacipran.

In these studies, 31% of people taking either duloxetine or milnacipran had at least 50% less pain after treatment. Of those taking a placebo (treatment with no active drug), 21% had the same result.

If you're interested in using Fetzima to treat fibromyalgia, talk with your doctor. They can discuss all your treatment options with you.

Fetzima and children

Fetzima is not FDA-approved for use in children (younger than 18 years of age).

In fact, the FDA has required the makers of Fetzima to include a boxed warning on this medication stating that the drug increases the risk of suicidal thoughts and behaviors in younger people. A boxed warning is the strongest warning required by the FDA. It alerts healthcare providers and patients about the risks of serious side effects seen with a drug.

The boxed warning for Fetzima describes an increased risk of suicidal thoughts and actions in children (under 18 years of age) and young adults (ages 24 years and younger).

Other drugs are available that can treat major depressive disorder (MDD), which is also called depression. Some drugs may be better suited for you than others. If you're interested in finding an alternative to Fetzima, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that's approved to treat one condition is used to treat a different condition.

Alternatives for major depressive disorder

Examples of other drugs that may be used to treat major depressive disorder (MDD) include:

You may wonder how Fetzima compares to other medications that are prescribed for similar uses. Here we look at how Fetzima and Effexor XR are alike and different.

About

Fetzima contains the drug levomilnacipran, while Effexor XR contains the drug venlafaxine.

Both Fetzima and Effexor XR belong to a class of antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs work by stopping the breakdown of certain chemicals (serotonin and norepinephrine) in your brain. This results in higher amounts of the chemicals, which improves mood and reduces feelings of depression.

Uses

Both Fetzima and Effexor XR are approved to treat major depressive disorder (MDD), also called depression, in adults. With this condition, you may have intense feelings of sadness, emptiness, lack of motivation or interest, or anger for extended periods of time. These symptoms can interfere with your daily life.

Effexor XR is also approved to treat:

Drug forms and administration

Fetzima comes as an extended-release capsule that's taken by mouth once daily. It can be taken with or without food at about the same time each day.

Effexor XR also comes as an extended-release capsule that's taken by mouth once daily. It should be taken with food at about the same time each day.

Side effects and risks

Fetzima and Effexor XR both belong to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). Therefore, both medications can cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Fetzima, with Effexor XR, or with both drugs (when taken individually).

  • Can occur with Fetzima:
  • Can occur with Effexor XR:
  • Can occur with both Fetzima and Effexor XR:
    • nausea
    • vomiting
    • constipation
    • decreased appetite
    • excessive sweating
    • erectile dysfunction (inability to have or keep an erection)

Serious side effects

These lists contain examples of serious side effects that can occur with Fetzima, with Effexor XR, or with both drugs (when taken individually).

* Fetzima and Effexor XR both have a boxed warning from the FDA regarding the risk of suicidal thoughts and behaviors. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

Fetzima and Effexor XR are both used to treat major depressive disorder (MDD) in adults.

These drugs haven't been directly compared in clinical studies. But separate studies have found both Fetzima and Effexor XR to be effective in treating MDD.

Costs

Fetzima comes as a brand-name drug, while Effexor XR comes as a brand-name and a generic drug (called venlafaxine extended-release). Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Effexor XR may cost more than Fetzima. The actual price you'll pay for either drug depends on your insurance plan, your location, whether you get the name-brand or generic drug, and the pharmacy you use.

You may wonder how Fetzima compares to other medications that are prescribed for similar uses. Here we look at how Fetzima and Pristiq are alike and different.

About

Fetzima contains the drug levomilnacipran, while Pristiq contains the drug desvenlafaxine.

Both Fetzima and Pristiq belong to a class of antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs work by stopping the breakdown of certain chemicals (serotonin and norepinephrine) in your brain. This results in higher amounts of the chemicals, which improves mood and reduces feelings of depression.

Uses

Both Fetzima and Pristiq are approved to treat major depressive disorder (MDD), also called depression, in adults. With this condition, you may have intense feelings of sadness, emptiness, lack of motivation or interest, or anger for extended periods of time. These symptoms can interfere with your daily life.

Drug forms and administration

Fetzima comes as an extended-release capsule that's taken by mouth once daily. It can be taken with or without food at about the same time each day.

Pristiq comes as an extended-release tablet that's taken by mouth once daily. It can be taken with or without food at about the same time each day.

Side effects and risks

Fetzima and Pristiq both belong to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). Therefore, both medications can cause very similar side effects. Below are examples of these side effects.

More common side effects

These lists contain examples of more common side effects that can occur with Fetzima, with Pristiq, or with both drugs (when taken individually).

  • Can occur with Fetzima:
  • Can occur with Pristiq:
  • Can occur with both Fetzima and Pristiq:
    • nausea
    • constipation
    • excessive sweating
    • decreased appetite
    • erectile dysfunction (inability to have or keep an erection)

Serious side effects

These lists contain examples of serious side effects that can occur with Fetzima, with Pristiq, or with both drugs (when taken individually).

* Fetzima and Pristiq both have a boxed warning from the FDA regarding the risk of suicidal thoughts and behaviors. A boxed warning is the strongest warning the FDA requires. It alerts doctors and patients about drug effects that may be dangerous.

Effectiveness

Fetzima and Pristiq are both used to treat major depressive disorder (MDD) in adults.

These drugs haven't been directly compared in clinical studies. But separate studies have found both Fetzima and Pristiq to be effective for treating MDD.

Costs

Fetzima is a brand-name drug, while Pristiq is available as a brand-name and a generic drug (called desvenlafaxine). Brand-name medications usually cost more than generics.

According to estimates on GoodRx.com, Fetzima and Pristiq generally cost about the same. The actual price you'll pay for either drug depends on your insurance plan, your location, whether you get the brand-name or generic drug, and the pharmacy you use.

You shouldn't stop taking Fetzima abruptly. Stopping treatment suddenly can cause dangerous side effects of withdrawal, including:

  • anxiety
  • anger
  • dizziness
  • electric shock sensations
  • confusion
  • headaches
  • ringing in the ears
  • inability to control your emotions
  • seizures

If you and your doctor decide to discontinue your Fetzima treatment, your doctor will recommend a safe way for you to taper off of the drug.

You shouldn't drink alcohol while you're using Fetzima. Drinking alcohol can increase your risk of side effects from Fetzima. This is because alcohol makes Fetzima capsules release the medication very quickly into your body.

Side effects that may occur if you drink alcohol while you're using Fetzima can include:

  • nausea
  • vomiting
  • excessive sweating
  • tachycardia (fast heart rate)
  • palpitations (feeling your heart beat flutter or skip a beat)

If you have questions about the safety of drinking alcohol while you're using Fetzima, talk with your doctor.

Fetzima can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Fetzima and other medications

Below are lists of medications that can interact with Fetzima. These lists do not contain all the drugs that may interact with Fetzima.

Before taking Fetzima, 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, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Fetzima and drugs that increase your risk of serotonin syndrome, such as Adderall

Certain drugs change the way your body regulates levels of serotonin (a certain brain chemical that helps to regulate mood). These drugs may interact with Fetzima and cause a buildup of serotonin in your body. This results in a dangerous condition called serotonin syndrome.

Symptoms of serotonin syndrome can include changes in your mental status (such as confusion or delirium), fever, dangerously high blood pressure, and even death.

Drugs that interact with Fetzima and can possibly cause serotonin syndrome if used together include:

  • certain ADHD (attention deficit hyperactivity disorder) drugs, such as:
    • amphetamine/dextroamphetamine (Adderall)
    • lisdexamfetamine (Vyvanse)
    • dextromethorphan (Robitussin DM)
  • certain pain medications, such as:
    • tramadol (Ultram)
    • meperidine (Demerol)
    • methadone (Dolophine)
  • certain antidepressants, such as:

If you're taking any of these medications with Fetzima, talk with your doctor. They may switch your current medications, modify your dosages, or monitor you more closely for serious side effects.

Fetzima and monoamine oxidase inhibitors

Certain drugs called monoamine oxidase inhibitors (MAOIs) cannot be taken with Fetzima. Taking these MAOIs with Fetzima increases your risk of serious side effects, including dangerously high blood pressure and serotonin syndrome. (See the section above for details on this syndrome.)

Examples of MAOIs include:

  • isocarboxazid (Marplan)
  • linezolid (Zyvox)
  • phenelzine (Nardil)
  • selegiline (Emsam)
  • tranylcypromine (Parnate)

If you're using an MAOI, and your doctor prescribes Fetzima, you'll have to stop taking the MAOI for at least 14 days before you start taking Fetzima. Talk with your doctor about all the medications you're taking before starting treatment with Fetzima.

Fetzima and certain drugs that increase your risk of bleeding

Certain drugs that stop your body from forming blood clots, which also increases your risk of bleeding, may interact with Fetzima. If taken with Fetzima, these drugs can further increase your risk of bleeding.

Examples of drugs that may increase your risk of bleeding if taken with Fetzima include:

Talk with your doctor about all the medications you're taking before starting treatment with Fetzima. If you're taking any of these medications with Fetzima, your doctor may monitor you closely and order certain blood tests. These blood tests will help your doctor make sure your risk of bleeding isn't increased during treatment.

If needed, your doctor may also adjust your dosage of these medications. Or they may change your medications altogether to reduce your risk of bleeding.

Fetzima and CYP3A4 inhibitors

Fetzima is metabolized (broken down) in your body by a protein called CYP3A4. Certain medications, called CYP3A4 inhibitors, can slow down the metabolism of Fetzima. Taking Fetzima with strong CYP3A4 inhibitors can cause a buildup of the Fetzima in your body, which increases your risk of side effects from the drug.

Examples of strong CYP3A4 inhibitors that may increase Fetzima levels if taken together include:

  • certain antifungal drugs, such as:
    • ketoconazole (Nizoral)
    • itraconazole (Sporanox, Tolsura)
  • certain antibiotics, such as:
    • clarithromycin (Biaxin)
    • telithromycin (Ketek)
    • nefazodone (Serzone)

Other medications can also inhibit CYP3A4. If you're taking a CYP3A4 inhibitor, or you're not sure if you're taking one, talk with your doctor. They'll make sure that your dosage for each drug is adjusted to a safe amount.

Fetzima and herbs and supplements

Fetzima may interact with certain herbs and supplements. Be sure and talk with your doctor or pharmacist about possible interactions before using any herbal or supplement products while taking Fetzima.

Fetzima and St. John's wort

St. John's wort is an herbal supplement that's sometimes used by people with depression. However, this herb has been shown to interact with antidepressants, such as Fetzima.

Taking Fetzima and St. John's wort together can increase your risk of developing serotonin syndrome. This is a dangerous condition caused by a buildup of serotonin (a certain brain chemical that helps to regulate mood) in your body.

Serotonin syndrome can cause changes in your mental status (such as confusion or delirium), fever, dangerously high blood pressure, or even death.

If you're taking St. John's wort, talk with your doctor about whether this herb is safe to use with Fetzima. Your doctor will likely recommend that you stop taking St. John's wort to avoid serious side effects.

As with all medications, the cost of Fetzima can vary. To find current prices for Fetzima in your area, check out Goodrx.com:

The cost you find on GoodRx.com is what you may pay without insurance. The actual price you'll pay depends on your insurance plan, your location, and the pharmacy you use.

Financial assistance

If you need financial support to pay for Fetzima, help is available. Allergan USA, Inc., the manufacturer of Fetzima, offers a savings card and mail-in rebate through the Fetzima Savings Program. For more information and to find out if you're eligible for support, call 800-678-1605 or visit the program website.

You should take Fetzima according to your doctor or healthcare provider's instructions.

When to take

Fetzima should be taken by mouth once each day. You can take Fetzima at any time of day, but you should try to take it at the same time each day.

To help make sure that you don't miss a dose, try setting a reminder in your phone. A medication timer may be useful, too.

Taking Fetzima with food

Fetzima can be taken with or without food.

Can Fetzima be crushed, split, or chewed?

No, Fetzima capsules shouldn't be opened, chewed, or crushed. They should be swallowed whole.

Fetzima is approved to treat major depressive disorder (MDD), which is also called depression. This condition can cause intense feelings of sadness, emptiness, lack of motivation or interest, and anger.

Fetzima belongs to a class of antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRIs). These drugs work by stopping the breakdown of certain chemicals (serotonin and norepinephrine) in your brain. This results in higher amounts of these chemicals in your body, which improves your mood and reduces feelings of depression.

How long does it take to work?

You may start seeing an improvement in some of your depression symptoms as soon as 1 to 2 weeks after starting Fetzima. Most of your symptoms should be improving after about 6 to 8 weeks of treatment.

If your symptoms don't improve after 6 to 8 weeks of treatment, you should talk with your doctor. Not seeing an improvement in your depression within this period of time could mean that Fetzima won't work for you. In that case, your doctor may recommend that you try medication other than Fetzima for your depression.

Fetzima hasn't been studied in pregnant women. In studies of other medications that are similar to Fetzima, pregnancy complications were seen when the drugs were taken during the third trimester of pregnancy.

Reports have also shown that newborns who were exposed to certain antidepressants during the third trimester of pregnancy needed the following after birth:

  • longer amount of time in the hospital
  • breathing support
  • feeding tubes

If you're pregnant or planning to become pregnant, talk with your doctor before starting Fetzima. It will be important for you to weigh the risks of depression with the potential risks of treatment. Your doctor can help you decide which treatment option is best for you.

It's not known if Fetzima is safe to take during pregnancy. If you or your sexual partner can become pregnant, talk with your doctor about your birth control needs while you're using Fetzima.

It's not known if Fetzima passes into human breast milk. In studies of other medications that are similar to Fetzima, side effects were seen in babies who were breastfed while their mothers were taking antidepressants.

Side effects reported in newborns who were exposed to certain antidepressants through breast milk include:

  • agitation
  • fussiness
  • reduced appetite
  • reduced weight gain

If you're breastfeeding or considering breastfeeding, talk with your doctor about whether it's safe for you to take Fetzima.

Here are answers to some frequently asked questions about Fetzima.

If I stop taking Fetzima, will I have withdrawal symptoms?

Yes, you could. You shouldn't stop taking Fetzima suddenly, as this can cause dangerous symptoms of withdrawal, including:

  • anxiety
  • anger
  • dizziness
  • electric shock sensations
  • confusion
  • headaches
  • ringing in your ears
  • inability to control your emotions
  • seizures

If you and your doctor decide that you should stop taking Fetzima, your doctor will recommend a safe way for you to slowly taper off of the drug. For more information, see the section "Fetzima withdrawal" above.

How long does Fetzima stay in my system?

About half of the amount of Fetzima you take in one dose is eliminated from your body after about 12 hours. The rest of the dose will be cleared from your body over about 3 to 4 days.

Is Fetzima a stimulant?

No, Fetzima isn't a stimulant. Fetzima contains the drug levomilnacipran. It belongs to a class of antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRIs).

These antidepressants work by stopping the breakdown of certain chemicals (serotonin and norepinephrine) in your brain. This results in higher amounts of these chemicals in your body, which leads to mood changes.

Some of the mood changes that result can be similar to those you'd have from a stimulant drug. Examples of these mood changes include:

Sometimes having excessive anxiety while you're taking Fetzima can be a sign of a serious problem. It could mean that Fetzima isn't working for you. For more information, see the section "Fetzima and anxiety" above.

If you have increased anxiety, or other concerning mood changes, while you're taking Fetzima, talk with your doctor. They can discuss possible treatment options with you.

Does Fetzima cause insomnia?

No, Fetzima doesn't usually cause insomnia (trouble sleeping). If you have insomnia while you're taking Fetzima, it could mean that Fetzima isn't working for you. Or it could mean that your depression is getting worse.

If you have trouble sleeping while you're taking Fetzima, talk with your doctor. They can discuss whether you should continue taking this drug.

Does Fetzima help treat fibromyalgia?

No, Fetzima isn't approved to treat fibromyalgia. The effectiveness and safety of Fetzima in people with fibromyalgia has not been shown in studies.

For more information on this condition, see the section "Fetzima uses" above.

Can Fetzima cause sexual problems?

Yes, Fetzima can cause sexual problems in some men. In clinical studies, men who took either Fetzima or a placebo (treatment with no active drug) had the following sexual symptoms:

  • erectile dysfunction, which occurred in 6% to 10% of men taking Fetzima (compared with 2% of men taking a placebo)
  • testicular pain, which occurred in 4% of men taking Fetzima (compared with less than 1% of men taking a placebo)
  • ejaculation problems, which occurred in 5% of men taking Fetzima (compared with less than 1% of men taking a placebo)

In the same studies, less than 2% of women who took Fetzima had sexual side effects.

If you have concerns about sexual side effects while using Fetzima, talk with your doctor. They can discuss ways to help reduce these side effects.

This drug comes with several precautions.

FDA warning: Suicidal thoughts and behavior

This drug has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

Fetzima can increase your risk of suicidal thoughts and behavior. This drug can also worsen your depression. These risks are highest during the first few weeks of treatment. If you have any thoughts of harming yourself, call your doctor right away.

Fetzima is not FDA-approved for use in children. However, in some studies, this drug increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults (ages 24 years or younger).

Other warnings

Before taking Fetzima, talk with your doctor about your health history. Fetzima may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Heart problems. Fetzima has been shown to cause increased blood pressure and increased heart rate. If you have high blood pressure or a heart conduction disorder (such as an arrhythmia or atrial fibrillation), Fetzima may worsen your condition. Talk with your doctor about any heart or blood pressure problems you have before you start taking Fetzima.
  • Glaucoma. If you have a type of glaucoma called angle closure glaucoma, Fetzima may cause further problems with your eyes. Fetzima causes your pupils to dilate (get larger), which may trigger a serious reaction called angle closure attack. Symptoms of this condition include severe eye pain, eye pressure, blurred vision, seeing haloes and lights, and having nausea or vomiting. This is a medical emergency. Call your doctor right away of you have these symptoms. Talk with your doctor about any eye problems you have before starting Fetzima.
  • Trouble urinating. Fetzima may cause trouble urinating or urinary hesitancy in some people. If you have trouble with urinating, Fetzima may worsen your condition. Talk with your doctor about urinary problems before you start Fetzima.
  • Bipolar disorder, mania, or hypomania. Fetzima can worsen the symptoms of bipolar disorder and may lead to manic episodes. If you have bipolar disorder, talk with your doctor before taking Fetzima.
  • Seizure disorder. Fetzima may lower your seizure threshold, which makes it more likely for you to have seizures. If you have a seizure disorder, or history of seizures, Fetzima may worsen your condition. Talk with your doctor about any history of seizures before starting Fetzima.
  • Pregnancy. Fetzima hasn't been studied in pregnant women. Other medications that are similar to Fetzima have caused pregnancy complications when taken during the third trimester of pregnancy. If you're pregnant or planning to become pregnant, talk with your doctor before starting Fetzima. For more information, please see the "Fetzima and pregnancy" section above.
  • Breastfeeding. It's not known for sure if Fetzima is safe to use while breastfeeding. If you're breastfeeding, talk with your doctor about whether this drug is safe to use. For more information, please see the "Fetzima and breastfeeding" section above.

Note: For more information about the potential negative effects of Fetzima, see the "Fetzima side effects" section above.

Using more than the recommended dosage of Fetzima can lead to serious side effects.

Overdose symptoms

Symptoms of an overdose can include:

What to do in case of overdose

If you think you've taken too much of this drug, call your doctor. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

When you get Fetzima from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee the effectiveness of the medication during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

Fetzima capsules should be stored at room temperature (77°F/25°C) in a tightly sealed container. Avoid storing this medication in areas where it could get damp or wet, such as in bathrooms.

Disposal

If you no longer need to take Fetzima and have leftover medication, it's important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

The following information is provided for clinicians and other healthcare professionals.

Indications

Fetzima is indicated to treat major depressive disorder (MDD) in adults.

Mechanism of action

Fetzima contains the active drug levomilnacipran, which is a serotonin-norepinephrine reuptake inhibitor (SNRI). Its mechanism has not been fully elucidated, but it is thought to potentiate serotonin and norepinephrine in the central nervous system through selective and potent inhibition of reuptake transporters.

Pharmacokinetics and metabolism

Fetzima has an elimination half-life of approximately 12 hours, with 92% relative bioavailability when taken orally. Time to peak plasma concentration is approximately 6 to 8 hours after oral administration. It is 22% bound to plasma proteins.

Fetzima is metabolized by desethylation to form several metabolites, which are then excreted along with active drug via renal elimination. The major enzyme involved in the metabolism of Fetzima is CYP3A4.

Contraindications

Fetzima is contraindicated in people who have a history of hypersensitivity to Fetzima or any of its components.

Fetzima is contraindicated for use in combination with monoamine oxidase inhibitors (MAOIs) due to the risk of serotonin syndrome. At least 14 days should elapse between discontinuation of an MAOI and initiation of Fetzima therapy. At least 7 days should elapse between discontinuation of Fetzima before starting an MAOI.

Storage

Fetzima tablets should be stored at room temperature (77°F/25°C) in a tightly sealed container away from light.

Disclaimer: Medical News Today 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 other 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.