Comprehensive medication guide to Levomilnacipran XR including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$10–$50 copay; Tier 3-4 formulary placement, prior authorization typically required
Estimated Cash Pricing
$458–$520 retail for brand; as low as $150–$400 with GoodRx or SingleCare coupons for generic
Medfinder Findability Score
60/100
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Levomilnacipran XR (brand name Fetzima) is an extended-release antidepressant medication approved by the FDA for treating Major Depressive Disorder (MDD) in adults. It belongs to a class of medications called serotonin-norepinephrine reuptake inhibitors (SNRIs). Unlike other SNRIs, levomilnacipran has a unique profile with approximately 15-fold higher selectivity for blocking norepinephrine reuptake compared to serotonin, making it particularly effective for depression with fatigue, low energy, and concentration problems.
Levomilnacipran XR works by blocking the reuptake (reabsorption) of two important neurotransmitters in the brain: serotonin and norepinephrine. By preventing these chemicals from being reabsorbed too quickly, more remains available in the brain to help regulate mood, energy, and emotional balance. The medication has a stronger effect on norepinephrine than serotonin, which may make it particularly helpful for depression symptoms like low energy, poor concentration, and motivation problems. The extended-release formulation provides steady medication levels throughout the day with once-daily dosing.
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20 mg extended-release capsules
Starting dose
40 mg extended-release capsules
Standard maintenance dose
80 mg extended-release capsules
Higher maintenance dose
120 mg extended-release capsules
Maximum recommended dose
Levomilnacipran XR (Fetzima) can be moderately challenging to find in stock at some pharmacies due to lower prescribing volume compared to other antidepressants. While not experiencing formal FDA shortages, many smaller pharmacies don't routinely stock it, requiring special orders that can take 1-3 days. Chain pharmacies like CVS, Walgreens, and Rite Aid typically have better availability, especially for common strengths (40mg, 80mg). Generic levomilnacipran ER is FDA-approved but may have even more limited availability than the brand.
Levomilnacipran XR can be prescribed by various healthcare providers including psychiatrists (mental health specialists), primary care physicians and family medicine doctors, internal medicine physicians, and neurologists. Many insurance plans require patients to try and fail 2-3 other formulary antidepressants before approving coverage for levomilnacipran XR. The medication is also available through teletherapy platforms and online psychiatric services for eligible patients.
No, Levomilnacipran XR is not a controlled substance. It is not scheduled by the DEA and does not have the same restrictions as controlled medications. However, it still requires a prescription from a healthcare provider and should not be stopped suddenly due to the risk of withdrawal symptoms. The medication carries an FDA black box warning about increased suicidal thoughts in young adults under 25.
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Venlafaxine XR (Effexor XR)
Another SNRI, widely available as generic, more serotonin-dominant. Used for depression, anxiety, and panic disorder.
Duloxetine (Cymbalta)
Most versatile SNRI, also approved for anxiety, diabetic neuropathy, fibromyalgia, and chronic pain. Generic available.
Desvenlafaxine (Pristiq)
SNRI with simpler metabolism, fewer drug interactions. Generic available.
Milnacipran (Savella)
The parent compound, FDA-approved for fibromyalgia with similar norepinephrine-dominant profile.
Bupropion (Wellbutrin)
Different mechanism (dopamine/norepinephrine), may be preferred if sexual side effects are a concern.
Prefer Levomilnacipran XR? We can find it.
MAOIs (monoamine oxidase inhibitors)
moderateDangerous interaction, must wait 14 days between medications
Other antidepressants
moderateRisk of serotonin syndrome when combined with SSRIs, other SNRIs, or tricyclics
Migraine medications (triptans)
moderateIncreased serotonin syndrome risk
Pain medications
moderateFentanyl, tramadol, and meperidine increase serotonin risk
Blood thinners
moderateNSAIDs, aspirin, and warfarin increase bleeding risk
Strong CYP3A4 inhibitors
moderateKetoconazole and clarithromycin require dose reduction to 80mg maximum
Blood pressure medications
moderateMay counteract effects due to norepinephrine activity
Levomilnacipran XR offers a unique treatment option for adults with Major Depressive Disorder, particularly those who haven't responded well to other antidepressants or who struggle with low energy and motivation. Its norepinephrine-dominant profile sets it apart from other SNRIs and may be beneficial for specific symptom profiles. However, availability can be challenging at some pharmacies, and insurance coverage often requires prior authorization and step therapy. Patients should work closely with their healthcare provider to determine if this medication is appropriate for their specific situation and to monitor for both effectiveness and potential side effects.
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