AdultPediatricDosage Forms & Strengths capsule, extended-release 20mg 40mg 80mg 120mg titration packs Contains two 20mg capsules and twenty-six 40mg capsules Major Depressive Disorders SNRI indicated for major depressive disorders in adults 20 mg PO qDay x2 days initially; THEN Increase to 40 mg PO qDay Based on efficacy and tolerability, increase dose in increments of 40 mg/day at intervals of 2 or more days; not to exceed 120 mg/day Dosage range: 40-120 mg/day Dosage Modifications Strong CYP3A4 inhibitors: Not to exceed 80 mg/day levomilnacipran maintenance dose Hepatic impairment: Hepatic elimination is low, no dosage adjustment required with mild, moderate, or severe hepatic impairment Renal impairment Mild (CrCl 60-89 mL/min): No dosage adjustment required Moderate (CrCl 30-59 mL/min): Not to exceed 80 mg/day maintenance dose Severe (CrCl 15-29 mL/min): Not to exceed 40 mg/day maintenance dose End-stage renal disease: Not recommended Dosing Considerations Not approved for the management of fibromyalgia Screen for personal or family history of bipolar disorder, mania, or hypomania before initiating antidepressantsSafety and efficacy not establishedInteraction CheckerEnter a drug name and levomilnacipranNo Results No Interactions Found Interactions FoundContraindicatedSerious - Use AlternativeSignificant - Monitor CloselyMinorAll Interactions Sort By: SeverityName Contraindicated (10)ethanolethanol will increase the level or effect of levomilnacipran by enhancing GI absorption. Applies only to oral form of both agents. Contraindicated. Alcohol interacts with the extended-release properties of levomilnacipran capsules resulting in a pronounced accelerated drug release iobenguane I 123levomilnacipran decreases effects of iobenguane I 123 by pharmacodynamic antagonism. Contraindicated. If clinically appropriate, discontinue drugs that decrease uptake of NE for at least 5 half-lives; may cause false-negative imaging results.isocarboxazidisocarboxazid and levomilnacipran both increase serotonin levels. Contraindicated. Do not use MAOIs intended to treat psychiatric disorders with levomilnacipran or within 7 days of stopping levomilnacipran due to an increased risk of serotonin syndromephenelzinephenelzine and levomilnacipran both increase serotonin levels. Contraindicated. Do not use MAOIs intended to treat psychiatric disorders with levomilnacipran or within 7 days of stopping levomilnacipran due to an increased risk of serotonin syndromeprocarbazineprocarbazine and levomilnacipran both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use.rasagilinerasagiline and levomilnacipran both increase serotonin levels. Contraindicated. Concomitant use with MAOIs or within 14 days of discontinuing treatment with an MAOI is contraindicated.safinamidelevomilnacipran, safinamide. Either increases toxicity of the other by serotonin levels. Contraindicated. Concomitant use could result in life-threatening serotonin syndrome.selegilineselegiline and levomilnacipran both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI useselegiline transdermalselegiline transdermal and levomilnacipran both increase serotonin levels. Contraindicated. Combination is contraindicated within 2 weeks of MAOI use tranylcyprominetranylcypromine and levomilnacipran both increase serotonin levels. Contraindicated. Do not use MAOIs intended to treat psychiatric disorders with levomilnacipran or within 7 days of stopping levomilnacipran due to an increased risk of serotonin syndromeSerious - Use Alternative (62)abametapirabametapir will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.amitriptylinelevomilnacipran and amitriptyline both increase serotonin levels. Avoid or Use Alternate Drug.amoxapinelevomilnacipran and amoxapine both increase serotonin levels. Avoid or Use Alternate Drug.apalutamideapalutamide will decrease the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.apixabanlevomilnacipran, apixaban. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.buspironelevomilnacipran and buspirone both increase serotonin levels. Avoid or Use Alternate Drug.ceritinibceritinib will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.chloramphenicolchloramphenicol will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.citalopramcitalopram and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions.clomipraminelevomilnacipran and clomipramine both increase serotonin levels. Avoid or Use Alternate Drug.cobicistatcobicistat will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Do not esceed 80 mg levominacipram dose once daily if coadministration necessarycyclobenzaprinelevomilnacipran and cyclobenzaprine both increase serotonin levels. Avoid or Use Alternate Drug.desipraminelevomilnacipran and desipramine both increase serotonin levels. Avoid or Use Alternate Drug.desvenlafaxinelevomilnacipran and desvenlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.dexmethylphenidatedexmethylphenidate and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.dextromethorphanlevomilnacipran and dextromethorphan both increase serotonin levels. Avoid or Use Alternate Drug.dolasetrondolasetron, levomilnacipran. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.dosulepinlevomilnacipran and dosulepin both increase serotonin levels. Avoid or Use Alternate Drug.doxepinlevomilnacipran and doxepin both increase serotonin levels. Avoid or Use Alternate Drug.duloxetineduloxetine and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.epinephrinelevomilnacipran increases levels of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.epinephrine racemiclevomilnacipran increases levels of epinephrine racemic by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.escitalopramescitalopram and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.fexinidazolefexinidazole will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.fluoxetinefluoxetine and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.fluvoxaminefluvoxamine and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.granisetrongranisetron, levomilnacipran. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.idelalisibidelalisib will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substratesimipraminelevomilnacipran and imipramine both increase serotonin levels. Avoid or Use Alternate Drug.iobenguane I 131levomilnacipran will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.ivosidenibivosidenib will decrease the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.linezolidlinezolid and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug. Linezolid may increase serotonin as a result of MAO-A inhibition. If linezolid must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last linezolid dose or after 2 weeks of monitoring, whichever comes first.lofepraminelevomilnacipran and lofepramine both increase serotonin levels. Avoid or Use Alternate Drug.lorcaserinlevomilnacipran and lorcaserin both increase serotonin levels. Avoid or Use Alternate Drug.maprotilinelevomilnacipran and maprotiline both increase serotonin levels. Avoid or Use Alternate Drug.meperidinelevomilnacipran and meperidine both increase serotonin levels. Avoid or Use Alternate Drug.methylene bluemethylene blue and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug. Methylene blue may increase serotonin as a result of MAO-A inhibition. If methylene blue must be administered, discontinue serotonergic drug immediately and monitor for CNS toxicity. Serotonergic therapy may be resumed 24 hours after last methylene blue dose or after 2 weeks of monitoring, whichever comes first.metoclopramidemetoclopramide and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug. Additive effects; increased risk for serotonin syndrome, neuroleptic malignant syndrome, dystonia, or other extrapyramidal reactionsmifepristonemifepristone will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.milnacipranlevomilnacipran and milnacipran both increase serotonin levels. Avoid or Use Alternate Drug.nefazodonelevomilnacipran and nefazodone both increase serotonin levels. Avoid or Use Alternate Drug.netupitant/palonosetronnetupitant/palonosetron, levomilnacipran. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.norepinephrinelevomilnacipran increases levels of norepinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of paroxysmal HTN, arrhythmia.nortriptylinelevomilnacipran and nortriptyline both increase serotonin levels. Avoid or Use Alternate Drug.ondansetronondansetron, levomilnacipran. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.ozanimodozanimod increases toxicity of levomilnacipran by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.palonosetronpalonosetron, levomilnacipran. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.paroxetinelevomilnacipran and paroxetine both increase serotonin levels. Avoid or Use Alternate Drug.phenterminelevomilnacipran and phentermine both increase serotonin levels. Avoid or Use Alternate Drug.protriptylinelevomilnacipran and protriptyline both increase serotonin levels. Avoid or Use Alternate Drug.pseudoephedrinelevomilnacipran increases effects of pseudoephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug.serdexmethylphenidate/dexmethylphenidateserdexmethylphenidate/dexmethylphenidate and levomilnacipran both increase serotonin levels. Avoid or Use Alternate Drug.sertralinelevomilnacipran and sertraline both increase serotonin levels. Avoid or Use Alternate Drug.St John's Wortlevomilnacipran and St John's Wort both increase serotonin levels. Avoid or Use Alternate Drug.tedizolidtedizolid, levomilnacipran. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.trazodonelevomilnacipran and trazodone both increase serotonin levels. Avoid or Use Alternate Drug.trimipraminelevomilnacipran and trimipramine both increase serotonin levels. Avoid or Use Alternate Drug.tucatinibtucatinib will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.venlafaxinelevomilnacipran and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.vilazodonelevomilnacipran, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated. .vortioxetinelevomilnacipran, vortioxetine. Either increases effects of the other by serotonin levels. Avoid or Use Alternate Drug.voxelotorvoxelotor will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.Monitor Closely (134)5-HTPlevomilnacipran and 5-HTP both increase serotonin levels. Modify Therapy/Monitor Closely.almotriptanalmotriptan and levomilnacipran both increase serotonin levels. Modify Therapy/Monitor Closely.aripiprazolelevomilnacipran, aripiprazole. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).asenapinelevomilnacipran, asenapine. unspecified interaction mechanism. Use Caution/Monitor. Serotonin modulators may enhance dopamine blockade, possibly increasing the risk for neuroleptic malignant syndrome. Antipsychotics may enhance serotonergic effect of serotonin modulators, which may result in serotonin syndrome. Monitor for evidence of serotonin toxicity (eg, mental status changes, autonomic instability, and neuromuscular hyperactivity) or neuroleptic malignant syndrome (eg, hyperthermia, muscle rigidity, autonomic dysfunction).aspirinlevomilnacipran, aspirin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.aspirin rectallevomilnacipran, aspirin rectal. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.aspirin/citric acid/sodium bicarbonatelevomilnacipran, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.atazanaviratazanavir will increase the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Do not exceed 80 mg/day of levomilnacipran when coadministered with strong CYP3A4 inhibitorsbenzhydrocodone/acetaminophenbenzhydrocodone/acetaminophen, levomilnacipran. Either increases effects of the other by serotonin levels. Use Caution/Monitor. Coadministration of drugs that affect the serotonergic neurotransmitter