Medical Editor: John P. Cunha, DO, FACOEP Last updated on RxList: 10/4/2021
Fetzima Side Effects Center

What Is Fetzima?

Fetzima (levomilnacipran) extended-release is a type of antidepressant called a serotonin and norepinephrine reuptake inhibitor (SNRI) used to treat Major Depressive Disorder (MDD).

What Are Side Effects of Fetzima?

Common side effects of Fetzima include:

Antidepressants such as Fetzima may increase suicidal thoughts in some children, teenagers, or young adults, particularly in the first few months of treatment. Tell your doctor if you have thoughts of suicide while taking Fetzima.

Dosage for Fetzima

The recommended dose range for Fetzima is 40 mg to 120 mg once daily, with or without food.

What Drugs, Substances, or Supplements Interact with Fetzima?

Fetzima may interact with medicines used to treat mood, anxiety, psychotic or thought disorders; migraine headache medicines (triptans); other antidepressants, antipsychotics, sibutramine, tramadol, tryptophan, St. John's Wort, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, warfarin, or diuretics. Tell your doctor all medications and supplements you use.

Fetzima During Pregnancy and Breastfeeding

During pregnancy, Fetzima should be used only if the potential benefit justifies the potential risk to the fetus. It is unknown if Fetzima passes into breast milk. Consult your doctor before breastfeeding.

Additional Information

Our Fetzima (levomilnacipran) extended-release Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.


Learn to Spot Depression: Symptoms, Warning Signs, Medication See Slideshow
Fetzima Consumer Information

Get emergency medical help if you have signs of an allergic reaction: skin rash or hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • blurred vision, tunnel vision, eye pain or swelling, eye redness;
  • painful or difficult urination;
  • easy bruising, unusual bleeding, purple or red spots under your skin;
  • pounding heartbeats or fluttering in your chest;
  • seizure (convulsions);
  • manic episodes--racing thoughts, increased energy, decreased need for sleep, risk-taking behavior, being agitated or talkative; or
  • low sodium level--headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady.

Serious side effects may be more likely in older adults.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common side effects may include:

  • nausea, vomiting, constipation;
  • irregular heartbeats;
  • sweating; or
  • decreased sex drive, impotence, or difficulty having an orgasm.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Fetzima (Levomilnacipran) Extended-release Capsules)


Depression is a(n) __________ . See Answer
Fetzima Professional Information


The following adverse reactions are discussed in greater detail in other sections of the label.

Clinical Studies Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in clinical practice.

Patient Exposure

The safety of FETZIMA was evaluated in 2,673 patients (18-78 years of age) diagnosed with MDD who participated in clinical studies, representing 942 patient-years of exposure. Among the 2,673 FETZIMA-treated patients, 1,583 were exposed to FETZIMA in short-term, placebo-controlled studies. There were 825 patients who continued from short-term studies into a one-year, open-label extension study.

Of the 2,673 patients exposed to at least one dose of FETZIMA, 737 patients were exposed to FETZIMA for at least 6 months and 367 were exposed for one year. In these studies FETZIMA was given at doses ranging from 40-120 mg once daily and was given without regard to food.

Adverse Reactions Reported As Reasons For Discontinuation Of Treatment

In the short-term placebo-controlled pre-marketing studies for MDD, 9% of the 1,583 patients who received FETZIMA (40-120 mg) discontinued treatment due to an adverse event, compared with 3% of the 1,040 placebo-treated patients in those studies. The most common adverse reaction leading to discontinuation in at least 1% of the FETZIMA-treated patients in the short-term placebo-controlled studies was nausea (1.5%).

Common Adverse Reactions In Placebo-Controlled MDD Studies

The most commonly observed adverse events in FETZIMA-treated MDD patients in placebo- controlled studies (incidence ≥ 5% and at least twice the rate of placebo) were: nausea, constipation, hyperhidrosis, heart rate increased, erectile dysfunction, tachycardia, vomiting, and palpitations.

Table 3 shows the incidence of adverse reactions that occurred in ≥ 2% of FETZIMA-treated MDD patients and at least twice the rate of placebo in the placebo-controlled studies.

Table 3: Adverse Reactions Occurring in ≥ 2% of FETZIMA-treated Patients and at Least Twice the rate of Placebo-treated Patients


System Organ Class
Preferred Term
(N =1040)
40-120 mg/d
(N = 1583)
Gastrointestinal disorders
Nausea 6 17
Constipation 3 9
Vomiting 1 5
Cardiac disorders
Tachycardiaa 2 6
Palpitations 1 5
Reproductive system and breast disordersb
Erectile dysfunctionc 1 6
Testicular paind <1 4
Ejaculation disordere <1 5
Heart rate increasedf 1 6
Blood pressure increasedg 1 3
Renal and urinary disorders
Urinary hesitation 0 4
Skin and subcutaneous tissue disorders
Hyperhidrosis 2 9
Rashh 0 2
Vascular disorders
Hot flush 1 3
Hypotensioni 1 3
Hypertensionj 1 3
Metabolism and nutrition disorders
Decreased appetite 1 3
a Tachycardia also includes: sinus tachycardia and postural orthostatic tachycardia syndrome
b Percentage is relative to the number of patients in the associated demographic sex category. Fewer than 2% of FETZIMA-treated MDD female patients in placebo-controlled clinical studies reported adverse events related to sexual function.
c erectile dysfunction includes: erectile dysfunction, organic erectile dysfunction and psychogenic erectile dysfunction
d testicular pain includes: testicular pain, epididymitis, and seminal vesiculitis
e ejaculation disorder includes: ejaculation disorder, ejaculation delayed, ejaculation failure, and premature ejaculation
f Heart rate increased also includes: orthostatic heart rate response increased
g Blood pressure increased also includes: blood pressure systolic increased, blood pressure diastolic increased and blood pressure orthostatic increased
h Rash also includes: rash generalized, rash maculo-papular, rash erythematous and rash macular
i Hypotension also includes: orthostatic hypotension and dizziness postural
j Hypertension also includes: labile hypertension
N = number of patients in the Safety Population

Dose-Related Adverse Reactions

In pooled data from the short-term placebo-controlled fixed-dose studies, there were no dose-related adverse reactions (greater than 2% overall incidence) in patients treated with FETZIMA across the dose range 40-120 mg once daily, with the exception of erectile dysfunction and urinary hesitation (see Table 4).

Table 4: Dose-Related Adverse Reactions

System Organ Class
Preferred Term
(N = 362)
40 mg/d
(N = 366)
80 mg/d
(N = 367)
120 mg/d
(N = 180)
Urinary hesitation 0 4 5 6
Erectile dysfunctiona 2 6 8 10
a Percentage is relative to the number of male patients.
N = number of patients in the Safety Population

Other Adverse Reactions Observed In Clinical Studies

Other infrequent adverse reactions, not described elsewhere in the label, occurring at an incidence of < 2% in MDD patients treated with FETZIMA were:

Cardiac disorders: Angina pectoris; Supraventricular and Ventricular extrasystoles

Eye disorders: Dry eye; Vision blurred; Conjunctival hemorrhage

General disorders: Chest pain; Thirst

Gastrointestinal disorders: Abdominal pain; Flatulence

Investigations disorders: Blood cholesterol increased; Liver function test abnormal

Nervous System disorders: Migraine; Paraesthesia; Syncope; Extrapyramidal disorder

Psychiatric disorders: Agitation; Anger; Bruxism; Panic attack; Tension; Aggression

Renal and Urinary disorder: Pollakiuria; Hematuria; Proteinuria

Respiratory, thoracic and mediastinal disorders: Yawning

Skin and subcutaneous tissue disorders: Dry skin; Pruritus; Urticaria

Postmarketing Experience

Besides these reactions reported under treatment with FETZIMA, other potentially severe adverse events have been reported from the post-marketing experience with milnacipran. Since levomilnacipran is the principal pharmacologically active component of milnacipran, one should take into account the fact that the following adverse event could also potentially occur under treatment with FETZIMA.

This adverse reaction includes: Takotsubo cardiomyopathy.

Read the entire FDA prescribing information for Fetzima (Levomilnacipran) Extended-release Capsules)

© Fetzima Patient Information is supplied by Cerner Multum, Inc. and Fetzima Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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