Only those who have experienced depression know how difficult it is to live with it. Sometimes your doctor may have prescribed you a medicine called Levomilnacipran as a treatment for this condition. You may find this medicine under the brand name Fetzima in Sri Lanka. So, as a user of this medicine, it is very important to know everything about it clearly. Today, let's talk about this medicine, how it works, and the things we need to be careful about.
What is this medicine? How does it work on the body?
Simply put, Levomilnacipran is a medication used to treat a condition called depression . The brain's nerve cells communicate with each other to control our mood, mood, and balance. Two special chemicals that help with this are serotonin and norepinephrine .
A person with depression may have some changes in the way these chemicals work in their brain. Levomilnacipran works by increasing the amount and activity of these chemicals in the brain called serotonin and norepinephrine. To be precise, this medicine belongs to a class of drugs called SNRI (Serotonin-Norepinephrine Reuptake Inhibitor) . This means that this medicine stops these chemicals from being reabsorbed into the nerve cells. Then, because they are present in the nerve cells for a longer time and in higher concentrations, the mood improves.
Things you need to tell your doctor before taking medicine
Before you start taking this medicine, it is very important to inform your doctor about your complete health history. This medicine may interact with some medical conditions. See the table below. If you have any of these conditions, be sure to tell your doctor.
| The situation or habit that applies to you | Why should you tell the doctor? |
|---|---|
| Frequent drinking | Side effects (especially dizziness) may increase. |
| Other mental illnesses (e.g. mania, bipolar disorder) | This medicine can change those conditions. |
| Heart disease , high blood pressure , or irregular heartbeat | This medicine may increase blood pressure and heart rate. |
| Kidney disease | The dosage of the medication may need to be changed. |
| Glaucoma is an eye disease. | Eye pressure may increase. |
| If you have had seizures | The risk of seizures may increase. |
| Bleeding disorders or taking medications that prevent blood clotting (e.g. Warfarin, Aspirin) | Increases the risk of abnormal bleeding. |
| If you or someone in your family has had suicidal thoughts | This is a very important matter. The doctor will be particularly concerned about this. |
| If you are pregnant , trying to get pregnant , or breastfeeding | Special attention is required because the medicine may affect the child. |
| Taking MAOI medications (e.g. Marplan, Nardil) | Taking these two medications together can be very dangerous. |
How should I use this medicine?
The method of using this medicine is very simple, but very important.
- Take this medicine with a glass of water. It doesn't matter whether you take it before or after a meal.
- Most importantly: Never break, crush, or chew the capsule. Swallow it whole . Otherwise, the medicine will be released into the body suddenly and can cause dangerous side effects.
- Take the medicine exactly as prescribed by your doctor, at the time prescribed. Do not change the dosage on your own.
- Do not stop taking the medicine suddenly for any reason without your doctor's advice. If you do, you may experience withdrawal symptoms, or your condition may get worse. If you do stop, do so as directed by your doctor, gradually reducing the dose.
What if I take too much medicine?
If you think you have taken too much medicine, immediately call the National Poisons Information Centre at the Colombo National Hospital . Or go to the Emergency Treatment Unit (ETU) of the nearest hospital. This is an emergency.
What to do if you miss a dose of medication?
We all forget to take our medicine. If that happens, take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next dose at the scheduled time. Never take two doses at once.
Other things that may interact with this medicine
Levomilnacipran is a drug that can interact with other medications, certain foods, and alcohol.
Do not take with these at all:
When taking this medication, it is strictly forbidden to take other SNRI drugs such as Duloxetine, Venlafaxine, Milnacipran, and MAOI drugs (such as Marplan, Nardil). Also, the antibiotic Linezolid and the vaccine Methylene blue may interact with this medication.
Be careful as these may also conflict with:
- Alcohol: Severely increases side effects such as dizziness and drowsiness.
- Painkillers: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aspirin, Ibuprofen, and Naproxen.
- Blood thinners: Warfarin, Enoxaparin, etc.
- Migraine medications: Triptan-type medications such as Sumatriptan.
- Medications and sleeping pills for other mental illnesses.
- Herbal supplements: especially St. John's Wort .
- Some antibiotics (Clarithromycin), antifungals (Ketoconazole), and medicines such as Isoniazid, which is used to treat TB.
So, when you go to see your doctor, bring a complete list of all the medications, vitamins, herbal remedies, and supplements you take. Don't forget to tell them if you smoke or drink alcohol.
Things to consider when taking medication
- Be patient: You won't see results immediately after taking this medicine. It may take several weeks to feel completely better. So, continue taking the medicine as long as your doctor tells you to.
- Watch for mood changes (very important): If you or someone in your family develops suicidal thoughts, becomes agitated, restless, irritable, or has trouble concentrating , especially when starting the medication or when the dosage is changed, call your doctor immediately. This is a very important warning.
- Blood pressure: This medication may slightly increase blood pressure. Therefore, measure your blood pressure at home as directed by your doctor.
- Dizziness and drowsiness: This medication may affect your ability to concentrate and react quickly. Therefore, avoid driving or operating machinery until you know how this medication affects you. To reduce dizziness, stand up slowly when getting up from a sitting position or getting out of bed.
- Dry mouth: This is a common side effect. This can be controlled by chewing sugar-free gum and drinking plenty of water.
What side effects might I experience?
Like any medication, this one can have side effects. Some of them are serious, some of them are common.
| Side effects that you should report to your doctor immediately | |
|---|---|
| Side effect | Description |
| Allergy | Skin rash, itching, swelling of the face, lips, tongue or throat. |
| Abnormal bleeding | Black or tarry stools, vomit that looks like coffee grounds, red/dark brown urine, red/purple spots on the skin. |
| Serotonin Syndrome | Confusion, restlessness, excessive sweating, high fever, muscle stiffness, convulsions. This is a dangerous condition. |
| Rapid heartbeat | Feeling like your heart is beating fast, pounding, or irregularly. |
| Increased blood pressure | Inform the doctor. |
| Decreased sodium in the blood | Muscle weakness, fatigue, dizziness, confusion. |
| Eye pain or vision changes | Sudden eye pain, blurred vision, seeing rings around lights. |
| Difficulty urinating | No or scanty urination. |
| Side effects that are usually not serious, but should be reported to the doctor if they persist | |
| Nausea and vomiting | It is more common in the early stages of starting the medication. |
| Constipation | Commonly seen. |
| Excessive sweating | - |
| Changes in sexual desire or function | Don't be shy about talking to your doctor about this. |
Take-Home Message
- Levomilnacipran (Fetzima) is a medication that treats depression and affects brain chemicals.
- Never break, crush, or chew the capsule. Swallow it whole.
- Avoid stopping the medication suddenly without your doctor's advice.
- Tell your doctor about all other medications, vitamins, and herbal supplements you are taking.
- If you experience mood swings or suicidal thoughts early in the treatment, seek medical advice immediately.
- Overdose is an emergency. Immediately go to the National Poisons Information Centre or the nearest hospital ETU .
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