Drug interactions
Levomilnacipran + Warfarin
Severity: Moderate
Levomilnacipran and Warfarin: 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
SNRIs deplete platelet serotonin and impair platelet aggregation, so combining levomilnacipran with warfarin raises the risk of bleeding, including gastrointestinal bleeding. The INR may not reflect this added risk.
What this interaction means in plain words
Levomilnacipran and Warfarin 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; Warfarin belongs to Cardiovascular.
Why it happens
Pharmacodynamic: inhibition of platelet serotonin uptake impairs platelet aggregation, adding to warfarin anticoagulation.
What to do
Monitor for signs of bleeding and check INR when starting or stopping levomilnacipran. Consider gastroprotection in patients at high risk of GI bleeding.
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 Warfarin
- Defibrotide + Warfarin Contraindicated
- Ketorolac + Warfarin Contraindicated
- Abciximab + Warfarin Major
- Acetylsalicylic acid + Warfarin Major
- Adagrasib + Warfarin Major
- Amiodarone + Warfarin 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 Warfarin?
MediHelp rates the interaction as moderate. Levomilnacipran and Warfarin 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. SNRIs deplete platelet serotonin and impair platelet aggregation, so combining levomilnacipran with warfarin raises the risk of bleeding, including gastrointestinal bleeding. The INR may not reflect this added risk.
How serious is the interaction between Levomilnacipran and Warfarin?
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 signs of bleeding and check INR when starting or stopping levomilnacipran. Consider gastroprotection in patients at high risk of GI bleeding.
What other medicines interact with Warfarin?
MediHelp also lists interactions of Warfarin with, for example, Defibrotide, Ketorolac, Abciximab. The full list is on the Warfarin page.
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