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Fetzima (levomilnacipran) 

Indications 

Fetzima are prescribed for the following conditions: 

• Major Depressive Disorder (MDD): Used for the treatment of major depressive episodes in adults. 
• Generalized Anxiety Disorder (GAD): Sometimes prescribed off-label for the treatment of generalized anxiety disorder in adults. 

Dosage and Administration 

• Take Fetzima exactly as prescribed by your doctor. The recommended starting dose is typically 20 mg once daily, which may be increased based on individual response and tolerability. 
• Take Fetzima at the same time each day, with or without food. 
• Swallow the capsule whole with water 
• Do not suddenly stop. Abrupt discontinuation of Fetzima may lead to withdrawal symptoms such as headache, nausea, dizziness, or flu-like symptoms. 

Mechanism of Action 

Fetzima is a serotonin-norepinephrine reuptake inhibitor (SNRI). It works by increasing the levels of serotonin and norepinephrine, two neurotransmitters in the brain associated with mood regulation. By inhibiting their reuptake, Fetzima helps restore balance in the brain and alleviate symptoms of depression and anxiety. 

Contraindications  

Fetzima should not be used if you: 

• Are Allergic to Levomilnacipran: Any known hypersensitivity to Levomilnacipran or any component of Fetzima capsules. 
• Are Taking MAOIs: Concurrent use with MAOIs or within 14 days of discontinuing an MAOI is contraindicated due to the risk of serotonin syndrome. 
• Have Uncontrolled Narrow-Angle Glaucoma: Levomilnacipran can increase intraocular pressure, exacerbating glaucoma. 

Side Effects 

Common Side Effects: 

• Nausea 
• Headache 
• Dizziness 
• Fatigue 
• Constipation 
• Dry mouth 

Serious Side Effects: 

• Suicidal Thoughts or Behavior: Especially in young adults, teenagers, or children. 
• Serotonin Syndrome: Symptoms may include agitation, hallucinations, fast heart rate, fever, sweating, shivering, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea. 
• Elevated Blood Pressure: Levomilnacipran may increase blood pressure, which can lead to complications such as stroke or heart attack. 

Precautions 

• Monitor mood changes by being vigilant for any signs of worsening depression or suicidal thoughts, especially at the beginning of your treatment or when your doses are adjusted. 
• Regularly monitor your blood pressure during treatment with Fetzima, particularly if you have hypertension or cardiovascular risk factors. 
• Provide your healthcare provider with a full list of all medications you are taking, including over-the-counter drugs and supplements. 
• Inform your doctor if you are pregnant, planning to become pregnant, or breastfeeding, as the safety of Fetzima during pregnancy and lactation is not well-established. 

Storage Instructions 

• Keep Fetzima capsules at a temperature between 68°F to 77°F (20°C to 25°C). 
• Store in a dry place; avoid bathrooms and kitchens where humidity is high. 

References 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/204168s006lbl.pdf