Levomilnacipran

Overview

Levomilnacipran capsule

Levomilnacipran is a serotonin-norepinephrine reuptake inhibitor (SNRI) used primarily in the treatment of major depressive disorder (MDD) in adults. It is the active enantiomer of milnacipran, which is also used to treat fibromyalgia. Levomilnacipran is marketed under the brand name Fetzima.

Mechanism of Action

Levomilnacipran functions by inhibiting the reuptake of two important neurotransmitters in the brain: serotonin and norepinephrine. By preventing the reabsorption of these neurotransmitters, levomilnacipran increases their availability in the synaptic cleft, which is believed to contribute to its antidepressant effects.

Pharmacokinetics

Levomilnacipran is administered orally and is well absorbed from the gastrointestinal tract. It undergoes hepatic metabolism primarily via the cytochrome P450 enzyme system, particularly CYP3A4. The drug and its metabolites are excreted mainly through the urinary system.

Clinical Use

Levomilnacipran is indicated for the treatment of major depressive disorder in adults. It is typically prescribed when other antidepressants have not been effective. The usual starting dose is 20 mg per day, which may be increased based on the patient's response and tolerability.

Side Effects

Common side effects of levomilnacipran include nausea, constipation, hyperhidrosis (excessive sweating), tachycardia (increased heart rate), and erectile dysfunction. Patients may also experience increased blood pressure and heart rate, so regular monitoring is recommended.

Contraindications

Levomilnacipran is contraindicated in patients with uncontrolled narrow-angle glaucoma, and it should not be used in conjunction with monoamine oxidase inhibitors (MAOIs) due to the risk of serotonin syndrome.

Related Pages

• Serotonin-norepinephrine reuptake inhibitor
• Major depressive disorder
• Milnacipran
• Serotonin syndrome