Levomilnacipran

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Information about Levomilnacipran

Levomilnacipran is a serotonin and norepinephrine reuptake inhibitor used to treat major depressive disorders. Levomilnacipran is an enantiomer of milnacipran, which is used to treat fibromyalgia.

Liver safety of Levomilnacipran

Levomilnacipran and milnacipran have been associated with a low rate of transient elevations in serum aminotransferase levels during treatment and with rare instances of clinically apparent acute liver injury with jaundice.

Mechanism of action of Levomilnacipran

Levomilnacipran (lee’ voe mil na’ si pran) is an oral serotonin and norepinephrine reuptake inhibitor (SNRI) that is used as a first line therapy of major depression. Levomilnacipran is the more active enantiomer of milnacipran (mil na’ si pran), which is used to treat fibromyalgia. Unlike other SNRIs such as duxoletine and venlafaxine, levomilnacipran is a more potent inhibitor of norepinephrine reuptake than serotonin reuptake.

FDA approval information for Levomilnacipran

Levomilnacipran was approved for use in the United States in 2007 and levomilnacipran in 2013. Despite the fact that they are identical in chemical structure, the only official current indication for milnacipran is fibromyalgia, and the sole indication for levomilnacipran is the treatment of major depressive disorders. Levomilnacipran has been evaluated as therapy of fibromyalgia and phantom limb syndrome, but is not approved for those uses.

Dosage and administration for Levomilnacipran

Milnacripran is available in 12.5, 25, 50 and 100 mg tablets and the recommended dosage is 50 mg twice daily after a 7 day titration schedule. Levomilnacipran is available in extended release capsules of 20, 40 80 and 120 mg under the brand name Fetzima. The recommended starting dosage is 20 mg once daily, with titration upwards by 20 mg every 2 days to a maximum daily dose of 120 mg.

Side effects of Levomilnacipran

Common side effects of milnacipran and levomilnacipran include nausea, vomiting, constipation, headache, sweating, increased heart rate, palpitations, testicular pain, urinary hesitancy and erectile dysfunction. When used with other serotonin reuptake inhibitors, milnacipran and levomilnacipran can be associated with acute serotonin syndrome of fever, tachycardia, anxiety and flushing.

The following antidepressant subclasses and drug records are discussed individually:

MAO Inhibitors Isocarboxazid, Phenelzine, Tranylcypromine

SNRIs Duloxetine, Levomilnacipran, Venlafaxine

SSRIs Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Vilazodone, Vortioxetine

Tricyclics Amitriptyline, Amoxapine, Clomipramine, Desipramine, Doxepin, Imipramine, Nortriptyline, Protriptyline, Trimipramine

Miscellaneous Bupropion, Flibanserin, Mirtazapine, Nefazodone, Trazodone


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