Drug interactions
Levomilnacipran + Milnacipran
Severity: Major
Levomilnacipran and Milnacipran: major interaction.
Last updated Sources: US FDA label
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
Levomilnacipran is the active enantiomer of milnacipran, so the two are essentially duplicate serotonin-norepinephrine reuptake inhibitors. Taking them together adds no benefit and raises the risk of serotonin syndrome, hypertension and tachycardia.
What this interaction means in plain words
Levomilnacipran and Milnacipran 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.
Levomilnacipran belongs to Central Nervous System; Milnacipran belongs to Central Nervous System.
Why it happens
Therapeutic duplication with additive inhibition of serotonin and norepinephrine reuptake.
What to do
Do not combine; use a single SNRI at an appropriate dose. When switching, stop one agent before starting the other and monitor for serotonergic symptoms.
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 Milnacipran
- Isocarboxazid + Milnacipran Contraindicated
- Methylene blue + Milnacipran Contraindicated
- Milnacipran + Phenelzine Contraindicated
- Milnacipran + Procarbazine Contraindicated
- Milnacipran + Rasagiline Contraindicated
- Milnacipran + Safinamide 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 Levomilnacipran with Milnacipran?
MediHelp rates the interaction as major. Levomilnacipran and Milnacipran 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. Levomilnacipran is the active enantiomer of milnacipran, so the two are essentially duplicate serotonin-norepinephrine reuptake inhibitors. Taking them together adds no benefit and raises the risk of serotonin syndrome, hypertension and tachycardia.
How serious is the interaction between Levomilnacipran and Milnacipran?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Do not combine; use a single SNRI at an appropriate dose. When switching, stop one agent before starting the other and monitor for serotonergic symptoms.
What other medicines interact with Milnacipran?
MediHelp also lists interactions of Milnacipran with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Milnacipran page.
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