Levomilnacipran Hydrochloride and Nefazodone Hydrochloride

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Talk to your doctor before using levomilnacipran together with nefazodone. Combining these medications can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. You should contact your doctor immediately if you experience these symptoms during treatment. Nefazodone may also increase the blood levels and effects of levomilnacipran. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Let your doctor know if your condition changes or you experience increased side effects. If you have high blood pressure, you may need closer monitoring of your blood pressure while you are receiving these medications. You should also avoid activities requiring mental alertness such as driving or operating machinery until you know how these medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

ADJUST DOSE: Coadministration with potent inhibitors of CYP450 3A4 such as nefazodone may increase the plasma concentrations of levomilnacipran, which is primarily metabolized by the isoenzyme. When coadministered with another potent CYP450 3A4 inhibitor, ketoconazole, levomilnacipran peak plasma concentration (Cmax) and systemic exposure (AUC) increased by approximately 1.4- and 1.6-fold, respectively, compared to administration alone. The interaction has not been studied with nefazodone, but similar pharmacokinetic changes for levomilnacipran should be expected.

MONITOR CLOSELY: Concomitant use of two or more agents with serotonergic activity may potentiate the risk of serotonin syndrome, which is a rare but serious and potentially fatal condition thought to result from hyperstimulation of brainstem 5-HT1A and 2A receptors. Symptoms of the serotonin syndrome may include mental status changes such as irritability, altered consciousness, confusion, hallucination, and coma; autonomic dysfunction such as tachycardia, hyperthermia, diaphoresis, shivering, blood pressure lability, and mydriasis; neuromuscular abnormalities such as hyperreflexia, myoclonus, tremor, rigidity, and ataxia; and gastrointestinal symptoms such as abdominal cramping, nausea, vomiting, and diarrhea.

MANAGEMENT: The dosage of levomilnacipran should not exceed 80 mg once daily when used with potent CYP450 3A4 inhibitors such as nefazodone. Patients should be closely monitored for symptoms of the serotonin syndrome during concomitant use. Particular caution is advised when increasing the dosages of these agents. If serotonin syndrome develops or is suspected during the course of therapy, all serotonergic agents should be discontinued immediately and supportive care rendered as necessary. Moderately ill patients may also benefit from the administration of a serotonin antagonist (e.g., cyproheptadine, chlorpromazine). Severe cases should be managed under consultation with a toxicologist and may require sedation, neuromuscular paralysis, intubation, and mechanical ventilation in addition to the other measures.

Levomilnacipran Hydrochloride

Generic Name: levomilnacipran

Brand name: Fetzima

Synonyms: Levomilnacipran

What is Levomilnacipran Hydrochloride?

Nefazodone Hydrochloride

Generic Name: nefazodone

Brand name: Serzone

Synonyms: Nefazodone

What is Nefazodone Hydrochloride?