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Fetzima Titration
Fetzima (generic name: levomilnacipran) is a serotonin-norepinephrine reuptake inhibitor (SNRI) used to treat major depressive disorder (MDD) in adults. It works by increasing the levels of serotonin and norepinephrine in the brain, which helps improve mood and alleviate depression symptoms. Fetzima is commonly initiated using a titration schedule to minimize side effects and allow the body to adjust to the medication.
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Frequently Asked Questions
How long does it take for Fetzima to start working?
It may take 2 to 4 weeks to start feeling the effects of Fetzima. Full benefits may not be seen until 6 to 8 weeks of treatment.
Can I stop taking Fetzima once I feel better?
No, you should not stop taking Fetzima without consulting your healthcare provider. Abruptly stopping can cause withdrawal symptoms, and your doctor may recommend gradually reducing the dose.
What should I do if I miss a dose of Fetzima?
If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose to make up for a missed one.
Is Fetzima safe to take with other antidepressants?
Fetzima should not be combined with other antidepressants, especially MAOIs or other SNRIs/SSRIs, without close medical supervision, as this may increase the risk of serotonin syndrome.
Can Fetzima cause weight gain?
While weight changes are possible with antidepressants, weight gain is not a common side effect of Fetzima. If you notice significant weight changes, consult your healthcare provider.
Comprehensive Drug Guide
How Does Fetzima Titration Work?
Levomilnacipran works by inhibiting the reuptake of serotonin and norepinephrine, two neurotransmitters involved in mood regulation. By increasing the levels of these neurotransmitters in the brain, Fetzima helps reduce symptoms of depression, including persistent sadness, fatigue, and lack of interest in daily activities.
Common Dosages
The usual dosage of Fetzima begins with a titration schedule to help the body adjust to the medication:
- Initial dose: 20 mg once daily for the first 2 days.
- Maintenance dose: Increase to 40 mg once daily after 2 days, with further increases up to 120 mg once daily as needed based on response and tolerance.
Typical Dosing
- For major depressive disorder: Start with 20 mg once daily for the first 2 days, followed by 40 mg once daily. The dose may be increased based on clinical response, up to a maximum of 120 mg once daily.
Typical Dosing
Who Shouldn't Take Fetzima Titration?
- Uncontrolled narrow-angle glaucoma.
- Concurrent use of monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping an MAOI due to the risk of serotonin syndrome.
- Hypersensitivity to levomilnacipran or any component of the formulation.
Advice From The Pharmacist
- Take Fetzima at the same time every day, with or without food. Swallow the capsules whole and do not crush or chew them.
- Follow the titration schedule provided by your healthcare provider to minimize side effects such as nausea or dizziness.
- It may take several weeks to experience the full effects of Fetzima. Do not stop taking the medication abruptly, as this can cause withdrawal symptoms.
- Avoid alcohol while taking Fetzima, as it can increase the risk of side effects like dizziness and drowsiness.
Side Effects of Fetzima Titration
Common Side Effects
- Nausea
- Dizziness
- Constipation
- Hyperhidrosis (excessive sweating)
- Increased heart rate (tachycardia)
Uncommon/Severe Side Effects
- Increased blood pressure
- Serotonin syndrome (symptoms include confusion, rapid heart rate, and agitation)
- Seizures
- Suicidal thoughts, particularly in young adults
Risks and Warnings of Fetzima Titration
- Serotonin Syndrome: Using Fetzima with other serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs, or triptans) can increase the risk of serotonin syndrome, a potentially life-threatening condition. Monitor for symptoms like agitation, hallucinations, or rapid heart rate.
- Increased Blood Pressure and Heart Rate: Fetzima can increase blood pressure and heart rate. Regular monitoring is recommended, especially for patients with pre-existing hypertension or heart conditions.
- Suicidal Thoughts: As with other antidepressants, Fetzima may increase the risk of suicidal thoughts or behaviors in young adults, particularly during the first few months of treatment. Patients should be closely monitored for changes in mood or behavior.
Interactions with Fetzima Titration
Common Drug Interactions
- Monoamine Oxidase Inhibitors (MAOIs): Do not use Fetzima with or within 14 days of stopping an MAOI, as this can lead to serotonin syndrome.
- Serotonergic drugs: Combining Fetzima with other serotonergic medications increases the risk of serotonin syndrome.
- Alcohol: Avoid alcohol as it can increase the risk of side effects, particularly dizziness and drowsiness.
- Stimulants: Medications like amphetamines or ADHD medications may increase the risk of elevated heart rate and blood pressure when used with Fetzima.
Alternatives to Fetzima Titration
- Venlafaxine (Effexor XR): Another SNRI commonly used for treating depression and anxiety disorders.
- Duloxetine (Cymbalta): An SNRI used for depression, anxiety, and certain types of chronic pain.
- Sertraline (Zoloft): A selective serotonin reuptake inhibitor (SSRI) often used for major depression and anxiety.
- Bupropion (Wellbutrin): An antidepressant that works differently from SNRIs and may be a good alternative for patients with certain side effects from SNRIs.
