Levomilnacipran
Levomilnacipran is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat major depressive disorder in adults. It works by increasing levels of serotonin and norepinephrine in the brain by preventing their reuptake, which helps improve mood and emotional regulation.
An SNRI antidepressant used to treat major depressive disorder by increasing serotonin and norepinephrine levels in the brain.
This medication carries a boxed (black box) warning — the strongest type of FDA warning. Review the full prescribing information before use.
Key facts at a glance
- ATC
- N06AX28
- RxNorm
- 1433212
- Generic
- Levomilnacipran
- Class
- atc-n06
- Brands
- Fetzima
- Availability
- rx
- Lactation
- unknown
- Routes
- oral
- Forms
- capsule
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 100-120mg daily
- Maximum
- consult physician
- Frequency
- divided into two doses (twice daily)
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- not FDA-approved for patients under 18 years
- Maximum
- consult physician
- Frequency
- not applicable
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- start with 20mg once daily, may increase to 40-120mg daily
- Maximum
- consult physician
- Frequency
- divided into two doses (twice daily)
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
7 groupspregnancy
first trimesteravoid if possible
use only if benefits outweigh potential risks to fetus
regular fetal monitoring recommended
Use with caution and monitor for adverse effects.
pregnancy
third trimestertaper before delivery if possible
consider tapering in third trimester; monitor newborn for withdrawal symptoms
monitor newborn for signs of poor feeding, respiratory distress, and withdrawal
Use with caution and monitor for adverse effects.
lactation
breastfeedinguse lowest effective dose
monitor infant for excessive drowsiness, poor feeding, or irritability; consider infant serum levels if symptoms occur
monitor infant for developmental milestones and adverse effects
Use with caution and monitor for adverse effects.
geriatric
elderlystart with lower dose, titrate slowly
begin at 20mg daily; maximum dose 120mg may not be tolerated; monitor for hyponatremia and bleeding risk
monitor blood pressure, weight, sodium levels, and for signs of serotonin syndrome
Use with caution and monitor for adverse effects.
pediatric_age
adolescents 12 17not recommended for pediatric use
not approved for patients under 18; limited efficacy and safety data available
monitor for worsening depression and suicidal ideation
Use with caution and monitor for adverse effects.
renal_impairment
severereduce dose to 20-40mg once daily
maximum dose 80mg daily for CrCl 15-29 mL/min; contraindicated for CrCl <15 mL/min
monitor renal function and for accumulation of drug
Use with caution and monitor for adverse effects.
hepatic_impairment
moderateuse with caution, no specific dose adjustment established
use lower end of dosing range; monitor for increased side effects
monitor liver function tests and for drug accumulation
Use with caution and monitor for adverse effects.
Statistics and clinical data
FDA approval year
FDA approval date for Fetzima
Drug class
Pharmacological classification
Indication
FDA-approved therapeutic indication
Mechanism of action
Primary pharmacological mechanism
Levomilnacipran is FDA-approved for the treatment of major depressive disorder (MDD) in adults.
It is a potent inhibitor of serotonin and norepinephrine reuptake at their respective transporters, increasing the availability of these neurotransmitters in the central nervous system to enhance neuronal communication and improve mood.
Common side effects may include nausea, headache, and increased blood pressure. It may increase suicidal thinking in young adults and should not be stopped abruptly. Patients should be monitored for serotonin syndrome, especially when combined with other serotonergic agents.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy