An SNRI antidepressant
Levomilnacipran
An SNRI antidepressant used to treat depression; it is largely a US product and not widely used in the UK.
What is Levomilnacipran?
Levomilnacipran is an antidepressant in the group called SNRIs (serotonin and noradrenaline reuptake inhibitors), used to treat depression. It works by boosting two brain chemicals, serotonin and noradrenaline, to help lift mood. Because it raises noradrenaline, it can increase blood pressure and heart rate, and it can cause difficulty passing urine. Like all antidepressants, it should not be stopped suddenly, as this causes withdrawal effects, and younger people are watched for any worsening of mood or suicidal thoughts when starting. It is largely a US product and is not widely available in the UK.
Education and reference only. This is a plain-language guide to Levomilnacipran — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Levomilnacipran is an antidepressant belonging to the SNRI group, which raise the levels of two brain chemicals, serotonin and noradrenaline. It is used to treat depression. It is closely related to milnacipran and is mainly a medicine of the United States, so it is not commonly used or widely available in the UK. It is taken by mouth, usually as a once-daily extended-release capsule, and is used under medical supervision like other antidepressants.
How it works
Levomilnacipran increases the amount of serotonin and noradrenaline available between nerve cells in the brain by stopping them being reabsorbed too quickly. These two chemicals are involved in mood, energy and concentration, and boosting them helps, over a few weeks, to lift low mood. Because it has a relatively strong effect on noradrenaline, it tends to raise blood pressure and heart rate and can affect the bladder, causing difficulty passing urine, more than some other antidepressants. The gradual build-up of effect is why it is taken regularly and judged over several weeks.
Company & origin
Originated / developed by: Specialist manufacturer.
An antidepressant in the SNRI group used to treat depression; it is largely a product of the United States and not widely available in the UK.
What it treats
Conditions Levomilnacipran is used for
Practical use
How to take Levomilnacipran
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it by mouth as prescribed, usually once a day, and swallow extended-release capsules whole.
- Give it a few weeks to work, as the benefit on mood builds gradually.
- Do not stop it suddenly; if it needs to be stopped, your prescriber will usually reduce it slowly to avoid withdrawal effects.
- Tell your prescriber if you have high blood pressure, heart problems or difficulty passing urine.
- Seek help promptly if your mood worsens or you have thoughts of harming yourself, especially early in treatment.
Weighing it up
Advantages & disadvantages of Levomilnacipran
Advantages
- Treats depression by boosting both serotonin and noradrenaline.
- Usually taken once a day by mouth.
- May suit people who have not done well on other antidepressants.
Disadvantages
- Can raise blood pressure and heart rate.
- Can cause difficulty passing urine and other effects linked to noradrenaline.
- Causes withdrawal effects if stopped suddenly, and is largely a US product not widely available in the UK.
Practical use
Good to know
The most useful things to know about levomilnacipran follow from it being an SNRI with a strong effect on noradrenaline. It can raise blood pressure and heart rate, so these are checked before and during treatment, especially in people who already have heart or blood-pressure problems. It can cause difficulty passing urine (urinary hesitancy), which is worth knowing about, particularly for older men or anyone with prostate trouble. Like all antidepressants, it takes a few weeks to work, must not be stopped abruptly because this causes withdrawal effects, and carries a need to watch younger people closely early on, as mood or suicidal thoughts can occasionally worsen before improving. It is largely a US product and not widely available in the UK.
Who should not take it / use with caution
- People who have had a serious allergic reaction to levomilnacipran should not take it.
- It should not be combined with MAOI antidepressants, because of the risk of a serious reaction.
- It is used with caution in people with uncontrolled high blood pressure, heart problems or difficulty passing urine.
- Care is needed in pregnancy and breastfeeding, under medical guidance.
Monitoring
- Checking blood pressure and heart rate before and during treatment.
- Reviewing mood and how well treatment is working over the first weeks.
- Watching younger people closely for any worsening of mood or suicidal thoughts early on.
Side effects
- A rise in blood pressure or heart rate.
- Difficulty passing urine (urinary hesitancy).
- Nausea, constipation, sweating or trouble sleeping.
- Less commonly, sexual difficulties or, rarely, a serotonin-related reaction when combined with certain other medicines.
Key interactions
- It must not be taken with MAOI antidepressants, and care is needed with other serotonin-boosting medicines.
- Other medicines that raise blood pressure or heart rate can add to those effects.
- Some medicines can change its level in the blood, so tell your prescriber everything you take.
Available as: Extended-release capsules taken by mouth.
Answers
Levomilnacipran: frequently asked questions
What is levomilnacipran used for?
It is an SNRI antidepressant used to treat depression, working by boosting the brain chemicals serotonin and noradrenaline to help lift mood.
Why does it affect blood pressure and heart rate?
It has a relatively strong effect on noradrenaline, which can raise blood pressure and heart rate, so these are checked before and during treatment.
Why might I have trouble passing urine?
Its effect on noradrenaline can cause difficulty passing urine, which is worth knowing about, particularly for older men or anyone with prostate trouble.
Can I stop it suddenly?
No. Like other antidepressants, it should not be stopped abruptly, as this causes withdrawal effects; your prescriber will usually reduce the dose slowly.
Is it available in the UK?
It is largely a US product and is not widely available or commonly used in the UK; other antidepressants are usually chosen here.
The wider class
About SNRI antidepressant
Levomilnacipran belongs to the snri antidepressant class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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