[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Serotonin-norepinephrine reuptake inhibitors (SNRIs)](https://durgical.com/en/pharmacology/classes/serotonin-norepinephrine-reuptake-inhibitors/) › Levomilnacipran # Levomilnacipran ## SNRIs? Serotonin-norepinephrine reuptake inhibitors (SNRIs) The active enantiomer of milnacipran: an SNRI for depression, excreted largely unchanged in urine. It can raise heart rate and cause sweating. Updated Nov 1, 2026 ## Quick facts **Group** [Serotonin-norepinephrine reuptake inhibitors (SNRIs)](https://durgical.com/en/pharmacology/classes/serotonin-norepinephrine-reuptake-inhibitors/) **Target** Serotonin (SERT) and noradrenaline (NET) transporters; NET shown **Used for** Major depressive disorder in adults **Key effects** Nausea · Excessive sweating · Fast heart rate **Monitor** Mood and suicidal thoughts · Urinary symptoms **ATC** N06AX28 No doses: the clinician sets them by the current guideline. On this page - The basics Mechanism of action - Indications - Adverse effects - Pharmacokinetics - Memory aid - Safety Contraindications - Key interactions - What is monitored - Administration and safety - Pregnancy and breastfeeding - Nursing care - Study Test yourself - Connections Connections ## Mechanism of action ⇄**Serotonin (SERT) and noradrenaline (NET) transporters; NET shown**Levomilnacipran ⓘ The figure shows the human noradrenaline transporter solved in the presence of levomilnacipran, with the milnacipran ligand in its central site. **Target in 3D:** Serotonin (SERT) and noradrenaline (NET) transporters; NET shown. PDB structure 9KDM (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/9KDM) · Drag to rotate · pinch to zoom Levomilnacipran is the active enantiomer of milnacipran. It blocks both the serotonin and noradrenaline transporters in a fairly balanced way, so more of both monoamines stays in the synapse; mood improves over weeks. The noradrenergic part explains sweating, fast heart rate and difficulty urinating. - Levomilnacipran blocks SERT and NET - More serotonin and noradrenaline in the synapse - Mood improves over weeks - Noradrenaline effects: sweating, fast pulse, urinary hesitancy ## Indications - Major depressive disorder in adults [Major depressive disorder →](https://durgical.com/en/conditions/major-depressive-disorder/) ## Adverse effects ### Common - Nausea, vomiting, constipation - Excessive sweating - Fast heart rate - Sexual dysfunction and erectile or ejaculation problems ### Serious (rare, important) - Suicidal thoughts in children, adolescents and young adults (boxed warning) - Serotonin syndrome - Abnormal bleeding - Angle-closure glaucoma; urinary retention; low sodium; seizures ## Contraindications - MAO inhibitors, including linezolid and intravenous methylene blue, now or within the previous two weeks - Starting an MAO inhibitor less than a week after stopping levomilnacipran ## Key interactions **MAO inhibitors, linezolid, methylene blue, St John's wort, tryptophan** Serotonin syndrome **Aspirin and NSAIDs** More bleeding **Alcohol** Worse side effects ## What is monitored - Mood and suicidal thoughts - Heart rate and blood pressure - Urinary symptoms - Sodium in older people ## Administration and safety - The extended-release capsule is swallowed whole, not opened, chewed or crushed - Not stopped without the treating team, who plan any change ## Pregnancy and breastfeeding Human data are limited; use weighs benefit and risk. ## Nursing care - Records heart rate and blood pressure - Asks about difficulty urinating, sweating and sexual side effects - Teaches the patient and family to report suicidal thoughts, agitation or eye pain with halos - Checks the list for MAO inhibitors, linezolid and NSAIDs ## Pharmacokinetics **Absorption** Well absorbed by mouth; extended-release capsule **Metabolism** Partly desethylated by CYP3A4 **Elimination** Largely unchanged in urine, so kidney function matters ## Memory aid «LEVO = the LEFT hand that works»: milnacipran's active mirror image, balanced SERT + NET, out through the kidney. ## Test yourself Think of the answer, then tap the question to see it. ## What is the relationship between levomilnacipran and milnacipran? Levomilnacipran is the active enantiomer of milnacipran. ## Which transporters does levomilnacipran block? Both the serotonin (SERT) and noradrenaline (NET) transporters. ## Why is kidney function relevant for levomilnacipran? It is excreted largely unchanged in the urine. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/levomilnacipran/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## Connections ## Related drugs 2 - [Duloxetine](https://durgical.com/en/pharmacology/duloxetine/) - [Venlafaxine](https://durgical.com/en/pharmacology/venlafaxine/) ## Related conditions 1 - [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/) [← Back to the class: Serotonin-norepinephrine reuptake inhibitors (SNRIs)](https://durgical.com/en/pharmacology/classes/serotonin-norepinephrine-reuptake-inhibitors/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [Levomilnacipran: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a613048.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N06AX28) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/levomilnacipran/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/levomilnacipran/