Fetzima (levomilnacipran) is a brand-name drug prescribed for major depressive disorder in adults. Fetzima comes as an extended-release oral capsule that’s typically taken once per day.

Fetzima belongs to a drug class called serotonin-norepinephrine reuptake inhibitors (SNRIs). Fetzima isn’t available in a generic version.

Keep reading for specific information about the dosage of Fetzima, including its strengths and how to take the medication. For a comprehensive look at Fetzima, see this article.

Note: This article describes typical dosages for Fetzima provided by the drug’s manufacturer. When taking Fetzima, always follow the dosage prescribed by your doctor.

Read below for recommended dosages of Fetzima and other details about the drug.

Fetzima form

Fetzima comes as an extended-release (ER) oral capsule. With ER medications, the drug is slowly released into your body over time.

Fetzima strengths

Fetzima comes in four strengths:

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

Typical dosages

Typically, your doctor will start by prescribing 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 prescribed or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Dosage for depression

Doctors may prescribe Fetzima to treat major depressive disorder (MDD), also called depression.

If your doctor prescribes Fetzima for depression, your starting dose will likely be 20 mg. Typically, you’ll take this once per day for 2 days. Then, your doctor will likely increase your dosage to 40 mg, taken once per day.

Your doctor may increase your daily dose by 40 mg as often as once every 2 days to treat your depression. The maximum recommended dosage of Fetzima is 120 mg once per day.

Sometimes, doctors prescribe a dose titration pack to slowly increase your dosage at the start of treatment. It contains two 20-mg capsules and 26 capsules in the 40-mg strength. If your doctor prescribes the titration pack, you’ll likely take one 20-mg capsule per day for the first 2 days of treatment. Then, you’ll take one 40-mg capsule per day for 26 days.

For more information about your specific dosage, talk with your doctor.

Long-term treatment

Before you start taking Fetzima, your doctor will discuss your treatment plan with you.

Fetzima is typically a long-term treatment. If you and your doctor determine that Fetzima is safe and effective for you, you’ll likely take it for several months or longer. Your doctor will monitor your symptoms to see if you still need to take Fetzima.

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

  • how your body responds to Fetzima
  • other medications you take
  • side effects you may have with Fetzima*
  • your kidney function

Other medical conditions you have can also affect your Fetzima dosage.

* To learn about Fetzima’s side effects, see this article.

Dosage adjustments

Your doctor may need to adjust your Fetzima dosage if you take certain medications. These include monoamine oxidase inhibitors (MAOIs) and drugs that can increase serotonin levels. They may also make an adjustment if you take certain CYP3A4* inhibitors. These medications can affect the level of Fetzima in your body. To find out what drugs may interact with Fetzima, see the “Interactions” section of this article.

Your doctor may also need to adjust your dosage if you have kidney disease.

Be sure to tell your doctor about all medications you take and any health conditions you may have.

* CYP3A4 is an enzyme (a type of protein) in the liver that breaks down medications.

Fetzima comes as a capsule you swallow whole. Do not divide, crush, or chew the capsule or place it in water. You may take your dose with or without food.

It may be helpful to take Fetzima around the same time every day. This helps maintain a steady level of the drug in your body so Fetzima can work effectively.

If you have trouble swallowing capsules, see this article for tips on how to take this form of medication. You can also talk with your doctor or pharmacist.

If you have questions about how to take Fetzima, talk with your doctor or pharmacist. You can also learn about taking Fetzima on the manufacturer’s website.


Some pharmacies offer labels with large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist might be able to recommend a pharmacy that does.

If you’re having trouble opening medication bottles, ask your pharmacist about putting Fetzima in an easy-open container. They also may recommend tools that can make it easier to open bottles.

If you miss a dose of Fetzima, take it as soon as you remember. But if it’s almost time for your next dose, skip the missed dose and take your next scheduled dose. Do not take two doses to make up for the missed one. If you’re not sure whether to take a missed dose or skip it, talk with your doctor or pharmacist.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm or putting a note where you’ll see it, such as on your bathroom mirror or bedside table. You could also download a reminder app on your phone.

If you need help remembering your appointments, try setting an alarm or downloading a reminder app on your phone.

It’s important that you do not take more Fetzima than your doctor prescribes. For some medications, taking more than the recommended amount may lead to harmful effects or overdose.

Effects of an overdose

There’s an increased risk of serotonin syndrome with an overdose of Fetzima. This condition is caused by high levels of the chemical serotonin.

Fetzima works by stopping the breakdown of serotonin and norepinephrine in your brain. This can increase the amount of these chemicals, which helps improve mood and reduce depression symptoms. However, high serotonin levels can result in serotonin syndrome. Symptoms can include:

If you take more than the recommended amount of Fetzima

Call your doctor right away if you believe you’ve taken too much Fetzima. Another option is to call America’s Poison Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.

It’s possible for treatment with Fetzima to cause dependence. This means you may have withdrawal symptoms if you suddenly stop taking Fetzima after taking it regularly for some time. (Withdrawal symptoms are side effects that happen after you stop taking a drug your body has become dependent on.)

Symptoms of withdrawal after abruptly stopping Fetzima include:

These symptoms can be very uncomfortable. However, they’re usually not life threatening.

You and your doctor will periodically reevaluate your need for Fetzima throughout your treatment. If a decision is made to stop your Fetzima treatment, your doctor will slowly lower your dose over time. This is known as a dose taper. A dose taper helps reduce your risk of withdrawal symptoms when you stop treatment with Fetzima.

Tapering your Fetzima dose could last several weeks or even months. The exact time needed to taper your dose depends on your Fetzima dosage and how long you’ve taken it.

Do not stop taking Fetzima unless your doctor specifically tells you to do so. If you have questions about your treatment for depression, talk with your doctor.

Below are some frequently asked questions about Fetzima.

Is it best to take my dose of Fetzima in the morning or at night?

You can take Fetzima at any time of day, but you should try to take it at the same time each day. This allows a steady level of medication to remain in your body to help treat your depression. (Fetzima is prescribed for MDD, a specific type of depression.)

To help make sure that you don’t miss a dose, try setting a reminder on your phone for the same time each day. A medication timer may be useful too. For details, see the “Missed dose” section above.

What is the recommended maximum dosage of Fetzima?

The maximum dosage of Fetzima that’s recommended is 120 mg per day. Typically, doctors prescribe a low dosage to start and may increase it with time. The highest dose of Fetzima recommended per day is 120 mg. In the drug’s clinical trials, no additional benefits were seen with doses larger than 120 mg. For details about Fetzima dosages, see the “Fetzima dosage” section above.

If you have questions or concerns about your dosage of Fetzima, talk with your doctor or pharmacist. If it seems like you need a higher dosage, ask your doctor whether a dosage increase is right for you. Do not increase your dosage unless your doctor recommends doing so.

How long does it take for Fetzima to start working?

Fetzima starts to work after your first dose. But it may take a few weeks before you start noticing a change in your depression symptoms.

If your symptoms don’t ease after 6–8 weeks of taking Fetzima, be sure to talk with your doctor. This may mean that Fetzima isn’t the right treatment option for you. Your doctor may recommend that you try other medications for your depression.

Talk with your doctor if you have questions about what to expect with Fetzima treatment.

The dosages in this article are typical dosages provided by the drug’s manufacturer. If your doctor recommends Fetzima for you, they’ll prescribe the dosage that’s right for you. Always follow the dosage that your doctor prescribes.

As with any drug, never change your dosage of Fetzima without your doctor’s recommendation. If you have questions about the dosage of Fetzima that’s best for you, talk with your doctor.

Besides learning about dosage, you may want other information about Fetzima. These additional articles might be helpful:

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 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.