levomilnacipran

Adjunctive therapy • Brands: Fetzima

Last reviewed: 2026-03-31

General information

Class: Adjunctive therapy
Common US brands: Fetzima
Typical dose range: Label initiation: 20 mg once daily for 2 days, then 40 mg once daily. The recommended dose range is 40–120 mg once daily, with or without food (label).
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2026-03-31

Dosing & forms

Forms/strengths: Extended-release capsules 20 mg, 40 mg, 80 mg, 120 mg (swallow whole).
Frequency: Label initiation: 20 mg once daily for 2 days, then 40 mg once daily. The recommended dose range is 40–120 mg once daily, with or without food (label).
Food: With or without food.
Typical range: Label initiation: 20 mg once daily for 2 days, then 40 mg once daily. The recommended dose range is 40–120 mg once daily, with or without food (label).

Mechanism (brief)

Serotonin-norepinephrine reuptake inhibitor (SNRI) with relatively greater norepinephrine reuptake inhibition; extended-release formulation for major depressive disorder.

Metabolism & Half‑life

Metabolism: CYP3A4, CYP2C8 (minor), CYP2C19 (minor), CYP2D6 (minor), CYP2J2 (minor)
Half‑life: Single-dose mean 12 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

View labelExact

Monitoring highlights

Blood pressure and heart rate at baseline and after titrations; ongoing monitoring is emphasized in labeling (label).
Renal function review for long-term therapy so dosing remains aligned with kidney function changes over time (label/clinical).
Screening for urinary obstruction risk and follow-up if urinary hesitation/retention symptoms emerge (label/clinical).
Suicidality and mood switching surveillance early in treatment and after dose changes, especially in young adults and bipolar-spectrum illness (label/clinical).

Sources

FETZIMA (levomilnacipran) extended-release capsules prescribing information — DailyMed (2025)
Consensus Guidelines for Therapeutic Drug Monitoring in Neuropsychopharmacology: Update 2017 — Pharmacopsychiatry (2018)
APA Clinical Practice Guideline for the Treatment of Depression — American Psychiatric Association (2023)
CANMAT 2024 Clinical Guidelines for Major Depressive Disorder — Canadian Journal of Psychiatry (2024)

General information

Class: Adjunctive therapy

Common US brands: Fetzima

Typical dose range: Label initiation: 20 mg once daily for 2 days, then 40 mg once daily. The recommended dose range is 40–120 mg once daily, with or without food (label).

Therapeutic drug monitoring not routinely recommended.

Last reviewed: 2026-03-31

Dosing & forms

Forms/strengths: Extended-release capsules 20 mg, 40 mg, 80 mg, 120 mg (swallow whole).

Frequency: Label initiation: 20 mg once daily for 2 days, then 40 mg once daily. The recommended dose range is 40–120 mg once daily, with or without food (label).

Food: With or without food.

Typical range: Label initiation: 20 mg once daily for 2 days, then 40 mg once daily. The recommended dose range is 40–120 mg once daily, with or without food (label).

Monitoring highlights

Blood pressure and heart rate at baseline and after titrations; ongoing monitoring is emphasized in labeling (label).

Renal function review for long-term therapy so dosing remains aligned with kidney function changes over time (label/clinical).

Screening for urinary obstruction risk and follow-up if urinary hesitation/retention symptoms emerge (label/clinical).

Suicidality and mood switching surveillance early in treatment and after dose changes, especially in young adults and bipolar-spectrum illness (label/clinical).