Highlighting uses, dosage, how to take & discontinue, side effects, pros & cons, and more


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Brand & Generic Names; Drug Classes

US brand name: Fetzima
Generic name: levomilnacipran extended-release

Drug Class(es)

Primary drug class: Antidepressants
Additional drug class(es): Serotonin and Norepinephrine Reuptake Inhibitors

Approved & Off-Label Uses (Indications)

Fetzima’s US FDA Approved Treatment(s)

short-term (8 weeks) treatment of Major Depressive Disorder (MDD).

Uses Approved Overseas but not in the US

Off-Label Uses of Fetzima

I have never seen this before:

Limitation of Use: FETZIMA is not approved for the management of fibromyalgia. The efficacy and safety of FETZIMA for the management of fibromyalgia have not been established. --the Fetzima PI sheet

Forest is specifically telling doctors and consumers to not use a med for an off-label purpose. While Forest has a vested interest in making sure people still buy Savella, based upon how Fetzima works, they do have a point. Fetzima isn’t going to make you puke like Savella, and it’s easier to take, but it won’t work as well for fibromyalgia or other forms of chronic pain than Savella will. BUT, a med you can tolerate that does a half-assed job is better than a med you literally can’t stomach. So if Savella works better for you than Cymbalta, but you can’t deal with the side effects, you may as well give Fetzima a shot. Just make sure the side effects weren’t from SSRI/SNRI discontinuation syndrome. If you were taking 60mg (or more) a day of Cymbalta and your doctor had you stop taking it all at once when starting you at 12.5 mg of Savella, find another doctor! Then consider giving Savella another chance.

When & If Fetzima Will Work

Fetzima’s Usual Onset of Action (when it starts working)

Like any SNRI, expect Fetzima to start working in 2 to 4 weeks. Return to Table of Contents

Likelihood of Working

Fetzima doesn’t seem to be much better than most antidepressants in the short-run. When it comes to long-term (maintenance) use,Fetzima is only so-so when it comes to keeping depression away.

Return to Table of Contents

Taking and Discontinuing

How to Take Fetzima

Manufacturer’s Recommendations

Forest Laboratories recommends:

The recommended dose range for FETZIMA is 40 mg to 120 mg once daily, with or without food. FETZIMA should be initiated at 20 mg once daily for 2 days and then increased to 40 mg once daily. Based on efficacy and tolerability, FETZIMA may then be increased in increments of 40 mg at intervals of 2 or more days. The maximum recommended dose is 120 mg once daily.

FETZIMA should be taken at approximately the same time each day. FETZIMA should be swallowed whole. Do not open, chew or crush the capsule.

 --the Fetzima PI sheet

Crazymeds’ Suggestions

Return to Table of Contents

How to Stop Taking Fetzima (discontinuation / withdrawal)

It’s an SNRI, so you had better do it as slowly and carefully as possible. Return to Table of Contents

Fetzima’s Pros and Cons


Return to Table of Contents


Return to Table of Contents

Interesting Stuff your Doctor Probably didn’t Tell You about Fetzima

Your doctor (or pharmacist) had better not skip this, but it’s one of the weirdest things I’ve read about a med: Alcohol turns Fetzima from an extended-release to immediate-release med. Basically, booze + Fetzima = Savella with less effect on pain. Return to Table of Contents

Best Known for

Return to Table of Contents

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Fetzima’s Potential Side Effects

Potential Side Effects All Crazy Meds Have

No matter which neurological and/or psychiatric drug you take, you’ll probably get one or more of these side effects. These will usually be gone, or at least will diminish to the point where you barely notice it most of the time, within a week or two.

  • Headache
  • Drowsiness / fatigue - even when taking stimulants in some circumstances.
  • Insomnia, instead of or alternating with the drowsiness.
  • Nausea
  • Assorted other minor GI complaints (constipation, diarrhea, etc.)
  • Generally feeling spacey / out of it
    • Which can all add up to the ever-helpful “flu-like symptoms” listed as an adverse event on the PI sheet of practically every medication on the planet used to treat almost any condition humans and other animals could have.1
  • All crazy meds can, and probably will affect your dreams as well. There is no way of telling if that will be good or bad, let alone if this side effect is permanent or temporary.
  • Any of the above side effects you see listed again below means they’re even more likely to happen and/or stick around longer and/or are worse than most other meds.

Typical Potential Side Effects

The usual for SNRIs. Return to Table of Contents

Uncommon Potential Side Effects

Return to Table of Contents

Freaky Rare Side Effects

Return to Table of Contents

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What You Really Need to be Careful About

Return to Table of Contents

Pregnancy Category

C-Use with caution Return to Table of Contents


Fetzima’s Half-Life & How Long Until It Clears Your System

12 hours. Clearance: 3 days.

Steady State

3 days

Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream2, so there’s nothing swimming around to attach itself to your brain and start doing stuff. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what3, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood.

Steady state is the flipside of half-life. This is when you can expect to get over side effects caused by fluctuating amounts of a medication in your bloodstream. Often, but not always the same amount of time as the plasma clearance above.

Return to Table of Contents

How levomilnacipran extended-release Works

the current best guess at any rate
Like Savella , Fetzima is an SNRI. Unlike Savella its action on serotonin and norepinephrine is fairly balanced.

Return to Table of Contents

Active Ingredient

levomilnacipran hydrochloride

The active ingredient is usually the same as the generic name, but more often than not it’s a chemical salt of the substance identified as the generic. E.g. Fluoxetine is the generic for Prozac, but the active ingredient is fluoxetine hydrochloride (or HCl). It usually doesn’t make much of a difference outside of the more esoteric aspects of a drug’s pharmacology, but not always.

Return to Table of Contents

Shelf Life

Return to Table of Contents

Fetzima’s Noted Drug-Drug, Drug-Food & Drug-Supplement Interactions

Alcohol. You cannot drink alcohol when taking Fetzima. Like Savella taking the two together will increase the chances of your liver imploding. More importantly: booze turns Fetzima from an extended-release to an immediate-release medication.

Return to Table of Contents

Check for Other Drug-Drug, Drug-Food & Drug-Supplement Interactions Fetzima may have at

Drugs.com’s drug-drug and drug-food interaction checker

It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on teh Faecesbooks.
Learn more about drug-everything interactions on our page of tips about taking crazy meds.

Name, Address, Serial Number (Generic and Overseas Availability)

Available in the US as a generic? No

Other Trade Names and Overseas Availability

Not including controlled/extended/sustained release suffixes (Efexor ER, Trevilor retard e.g.) or branded generics that are a hyphenate of the generic name and the drug company name (Apo-Citalopram e.g.).

Return to Table of Contents

Shapes & Sizes (How Supplied)

Fetzima comes in capsules imprinted with FL and the dosage in black. Dosages and colors are:

  • 20 mg yellow and white capsule
  • 40 mg yellow capsule
  • 80 mg pink and white capsule
  • 120 mg pink capsule

Return to Table of Contents

Comments, PI Sheet, Ratings, Reviews and More


This page really isn’t ready yet. As I’ve been updating pages on antidepressants I linked to it just to get that out of the way. And people are finding it via the site search engine, Google, or whatever.

Return to Table of Contents

Rate Fetzima

Give your overall impression of Fetzima on a scale of 0 to 5.

Get all critical about Fetzima

3.5 stars Rating 3.2 out of 5 from 6 criticisms.
Vote Distribution: 1 – 0 – 1 – 1 – 1 – 2

Rate this article

If you’re still feeling judgmental as well as just mental4, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.

Get all judgmental about the Fetzima (levomilnacipran extended-release) Synopsis

4 stars Rates 4.0 out of 5 from 9 value judgments.
Vote Distribution: 0 – 0 – 0 – 3 – 3 – 3

Return to Table of Contents

Pages and Forum Topics Google Thinks are Relevant to Your Mental Health

Full US PI sheet, Global SPCs & PILs, Other Consumer Review & Rating Sites, and Other Sites that may be of Interest

Fetzima’s Full US Prescribing Information / PI Sheet

Other Sites of Interest

Return to Table of Contents

Discussion board

If you have any questions not answered here, please see the Crazymeds Fetzima discussion board. Return to Table of Contents

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  1. Fetzima full US Prescribing Information
  2. Gommoll, Carl P., William M. Greenberg, and Changzheng Chen. “A randomized, double-blind, placebo-controlled study of flexible doses of levomilnacipran ER (40-120 mg/day) in patients with major depressive disorder.” Journal of Drug Assessment 3.0 (2014): 10-19.
  3. Bakish, David, Anjana Bose, Carl Gommoll, Changzheng Chen, Rene Nunez, William M. Greenberg, Michael Liebowitz, and Arif Khan. “Levomilnacipran ER 40 mg and 80 mg in patients with major depressive disorder: a phase III, randomized, double-blind, fixed-dose, placebo-controlled study.” Journal of Psychiatry & Neuroscience: JPN 39, no. 1 (2014): 40.
  4. Shiovitz, Thomas, William M. Greenberg, Changzheng Chen, Giovanna Forero, and Carl P. Gommoll. “A Randomized, Double-blind, Placebo-controlled Trial of the Efficacy and Safety of Levomilnacipran ER 40-120mg/day for Prevention of Relapse in Patients with Major Depressive Disorder.” Innovations in Clinical Neuroscience 11, no. 1-2 (2014): 10.
  5. Blum, Steven I., Stavros Tourkodimitris, and Adam Ruth. “Evaluation of functional health and well-being in patients receiving levomilnacipran ER for the treatment of major depressive disorder.” Journal of Affective Disorders (2014).
  6. Mago, Rajnish, Giovanna Forero, William M. Greenberg, Carl Gommoll, and Changzheng Chen. “Safety and Tolerability of Levomilnacipran ER in Major Depressive Disorder: Results from an Open-Label, 48-Week Extension Study” Clinical Drug Investigation 2013; 33(10): 761–771. Published online 03 September, 2013
  7. Carrothers, Timothy J., Tatiana Khariton, C. Chen, Antonia Periclou, Laishun Chen, Michelle Green, Leon Bax, Helen Kastrissios, and Parviz Ghahramani. “Population pharmacokinetic model for levomilnacipran in healthy subjects and patients with major depressive disorder.” In American Conference on Pharmacometrics, pp. 12-15. 2013.

Return to Table of Contents

1 As well as being an indication of half of said conditions.

2 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady state if they can't get, or won't provide a number for that.

3 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.

4 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!

5 At least links to all the ones with free full-text. Which are about half of those available for Savella. And nothing when compared with the all-except-one count for Brintellix. Hiding anything Forest? Not really. I was lucky to find one or two clinical trials for most other meds. And the one about long-term use being a statistical deadheat was available.

If you have any questions not answered here, please see the Crazymeds Fetzima discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)

Last modified on Wednesday, 04 May, 2016 at 17:16:50 by JerodPoorePage Author Date created
“Fetzima (levomilnacipran extended-release): a Review for the Educated Consumer.” by Jerod Poore is copyright © 2014 Jerod Poore Published online 2014/10/08
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Fetzima, and all other drug names on this page and used throughout the site, are a trademark of someone else. Fetzima’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.

Page design and explanatory material by Jerod Poore, copyright © 2003 - 2016. All rights reserved.
Keep up with Crazymeds and and/or my slow descent into irreparable madness boring life. Pick your preferred social media target(s):

Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, and 2016 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
Crazymeds now uses a secure server, but it is not so secure that you can discuss anything having to do with nuclear power facilities, air traffic control systems, aircraft navigation systems, weapons control systems, or any other system requiring failsafe operation whose failure could lead to injury, death or environmental damage. Just so you know. So if you’re mentally interesting and have a job that deals with that sort of thing, talk about said job elsewhere. Otherwise feel free to discuss your meds and brain cooties.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

‘Everything is true, nothing is permitted.’ - Jerod Poore

1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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