Drug interactions
Levomilnacipran + Pimavanserin
Severity: Moderate
Levomilnacipran and Pimavanserin: moderate interaction.
Last updated
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 a serotonin-norepinephrine reuptake inhibitor that can cause serotonin toxicity, and antipsychotic dopamine blockade may add neuroleptic malignant syndrome risk. The risk with pimavanserin is mainly theoretical.
What this interaction means in plain words
Levomilnacipran and Pimavanserin can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Levomilnacipran belongs to Central Nervous System; Pimavanserin belongs to Central Nervous System.
Why it happens
Additive serotonergic and dopaminergic modulation; no well-established pharmacokinetic mechanism.
What to do
Monitor for serotonin toxicity (agitation, tremor, clonus, hyperthermia) and neuroleptic malignant syndrome, especially after dose changes. Instruct patients to report these symptoms.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Pimavanserin
- Lefamulin + Pimavanserin Contraindicated
- Pimavanserin + Pimozide Contraindicated
- Pimavanserin + Vandetanib Contraindicated
- Adagrasib + Pimavanserin Major
- Amiodarone + Pimavanserin Major
- Amisulpride + Pimavanserin Major
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 Pimavanserin?
MediHelp rates the interaction as moderate. Levomilnacipran and Pimavanserin can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Levomilnacipran is a serotonin-norepinephrine reuptake inhibitor that can cause serotonin toxicity, and antipsychotic dopamine blockade may add neuroleptic malignant syndrome risk. The risk with pimavanserin is mainly theoretical.
How serious is the interaction between Levomilnacipran and Pimavanserin?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for serotonin toxicity (agitation, tremor, clonus, hyperthermia) and neuroleptic malignant syndrome, especially after dose changes. Instruct patients to report these symptoms.
What other medicines interact with Pimavanserin?
MediHelp also lists interactions of Pimavanserin with, for example, Lefamulin, Pimozide, Vandetanib. The full list is on the Pimavanserin page.
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