Cipran-80 ER

Indications

Levomilnacipran is an antidepressant used in adults to treat major depressive disorder (long-lasting low mood that affects daily life).

How It Works

Levomilnacipran is a serotonin and noradrenaline reuptake inhibitor (SNRI). It increases the levels of serotonin and noradrenaline, two natural brain chemicals that help regulate mood, energy and motivation. It acts somewhat more on noradrenaline than many similar medicines.

Dosage and Administration

Take it exactly as prescribed. It comes as extended-release capsules taken once a day at about the same time, with or without food. The doctor starts with a low dose and increases it step by step depending on how you respond. Swallow the capsule whole; do not open, crush or chew it. Improvement usually takes two to four weeks. Do not stop suddenly; your doctor will lower the dose gradually.

Interactions

• MAO inhibitors, Linezolid or intravenous Methylene Blue: must not be combined; allow at least 14 days between an MAO inhibitor and this medicine, and 7 days after stopping it before starting an MAO inhibitor.
• Other medicines that raise serotonin, such as other antidepressants, Tramadol, triptans, Lithium or St John's wort: risk of serotonin syndrome.
• Aspirin, NSAID painkillers, Warfarin and other blood thinners: higher bleeding risk.
• Strong CYP3A4 inhibitors such as Ketoconazole or Clarithromycin: raise levels, so a lower dose may be needed.
• Alcohol: avoid.

Contraindications

• Allergy to Levomilnacipran or Milnacipran.
• Use with, or within 14 days of, an MAO inhibitor.
• Uncontrolled narrow-angle glaucoma.

Side Effects

Common side effects include nausea, constipation, sweating, fast heartbeat, raised blood pressure, difficulty passing urine, erectile or ejaculation problems, dizziness and vomiting.

Get urgent medical help if you have thoughts of harming yourself, agitation with high fever, muscle stiffness or confusion (possible serotonin syndrome), unusual bleeding, inability to pass urine, eye pain with blurred vision, fits, or signs of a severe allergic reaction.

Pregnancy and Lactation

Use in pregnancy only after discussing the benefits and risks with your doctor; use late in pregnancy may affect the newborn. Speak to your doctor before breastfeeding, as the medicine may pass into breast milk.

Precautions and Warnings

• Antidepressants may increase suicidal thoughts in children, teenagers and young adults, especially early in treatment or after a dose change. Family members should watch for mood changes.
• Blood pressure and heart rate should be checked regularly.
• Tell your doctor about bipolar disorder, seizures, glaucoma, urinary problems, heart disease or low sodium.
• Kidney problems may need a lower dose.
• It may cause dizziness; take care when driving.

Overdose

An overdose may cause fast heartbeat, high blood pressure, drowsiness, fits or serotonin syndrome. Seek emergency medical help at once.

Therapeutic Class

Antidepressant, serotonin and noradrenaline reuptake inhibitor (SNRI).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.