Drug interactions
Dextromethorphan + Levomilnacipran
Severity: Major
Dextromethorphan and Levomilnacipran: major interaction.
Last updated Sources: Health Canada product monograph
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Dextromethorphan has serotonergic activity and combining it with a serotonin-norepinephrine reuptake inhibitor may precipitate serotonin syndrome. Features include agitation, tremor, diarrhea, hyperthermia and clonus.
What this interaction means in plain words
Dextromethorphan and Levomilnacipran can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Dextromethorphan belongs to Respiratory; Levomilnacipran belongs to Central Nervous System.
Why it happens
Additive serotonergic effects from serotonin reuptake inhibition and dextromethorphan activity.
What to do
Avoid the combination where possible and choose a non-serotonergic cough suppressant. If used, monitor for signs of serotonin toxicity and stop dextromethorphan if they appear.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Dextromethorphan
- Dextromethorphan + Isocarboxazid Contraindicated
- Dextromethorphan + Linezolid Contraindicated
- Dextromethorphan + Phenelzine Contraindicated
- Dextromethorphan + Rasagiline Contraindicated
- Dextromethorphan + Safinamide Contraindicated
- Dextromethorphan + Selegiline Contraindicated
Other interactions of Levomilnacipran
- Isocarboxazid + Levomilnacipran Contraindicated
- Levomilnacipran + Linezolid Contraindicated
- Levomilnacipran + Methylthioninium chloride Contraindicated
- Levomilnacipran + Phenelzine Contraindicated
- Levomilnacipran + Procarbazine Contraindicated
- Levomilnacipran + Rasagiline Contraindicated
Frequently asked questions
Can I take Dextromethorphan with Levomilnacipran?
MediHelp rates the interaction as major. Dextromethorphan and Levomilnacipran can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Dextromethorphan has serotonergic activity and combining it with a serotonin-norepinephrine reuptake inhibitor may precipitate serotonin syndrome. Features include agitation, tremor, diarrhea, hyperthermia and clonus.
How serious is the interaction between Dextromethorphan and Levomilnacipran?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible and choose a non-serotonergic cough suppressant. If used, monitor for signs of serotonin toxicity and stop dextromethorphan if they appear.
What other medicines interact with Dextromethorphan?
MediHelp also lists interactions of Dextromethorphan with, for example, Isocarboxazid, Linezolid, Phenelzine. The full list is on the Dextromethorphan page.
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