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    Fetzima

    Drug - Fetzima™(levomilnacipran) [Forest Laboratories, Inc]

    March 2014

    Therapeutic area - Antidepressant

    Approval criteria

    • Patient is 18 years of age or older AND
    • Patient has a diagnosis of major depressive disorder AND
    • Patient has tried and failed two separate 2-month trials of 2 preferred SSRIs AND
    • Patient has a documented intolerance/contraindication to OR has tried and failed a 2-month trial of 1 other preferred new generation antidepressant (i.e. venlafaxine, bupropion, mirtazapine or a tri-cyclic antidepressant). 

    Selective Serotonin Reuptake Inhibitors

    Preferred  Nonpreferred

    citalopram
    escitalopram
    fluoxetine
    paroxetine
    Pexeva
    sertraline

    Celexa
    Lexapro
    Paxil /Paxil CR
    Prozac
    Fluoxetine DR (weekly)
    Prozac Weekly
    paroxetine suspension
    Sarafem
    Viibryd*
    Zoloft 

    * individual PA criteria apply

    New Generation Antidepressants

    Preferred  Nonpreferred

    bupropion IR, SA, XL
    fluvoxamine
    mirtazapine
    nefazodone
    trazodone
    venlafaxine extended release
    venlafaxine extend release tablets (generic)

    		 Aplenzin* (bupropion HBr)
    Cymbalta
    Desyrel
    Effexor, Effexor XR
    Luvox CR*
    Pristiq*
    Remeron
    Wellbutrin/SR/XL

    * individual PA criteria apply

    Quantity limits

    Quantity Limit = 34 (All strengths); 28 for starter kit

    Background information

    Fetzima (levomilnacipran) is a serotonin and norepinephrine reuptake inhibitor (SNRI) indicated for the treatment of major depressive disorder (MDD) in adults. Levomilnacipran is titrated to the recommended dose range of 40 to 120 mg once daily with or without food. There are many other drugs indicated in the initial treatment of MDD including: tricyclic antidepressants (TCAs), SSRIs, SNRIs, bupropion and mirtazapine.

    Rationale

    The most recent guidelines published by Kaiser Permanente Care Management Institute in 2006 for the treatment of depression in primary care recommend SSRIs, TCAs, serotonin norepinephrine reuptake inhibitors SNRIs, and dopamine agonists as first-line treatment of MDD. The preference of antidepressant is based on patient’s history with drug treatment, clinician choice, adverse effects, among other factors. There are no clinical trials comparing the efficacy or safety of levomilnacipran to other antidepressants. It is not clear if levomilnacipran offers any unique efficacy or safety advantage over existing therapies.

    Questions?

    MHCP Provider Call Center 651-431-2700 or 800-366-5411

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