Generic Name Milnacipran Levomilnacipran Vortioxetine Vilazodone Brand Name Savella Fetzima Trintellix Viibryd Indications Treatment of Fibromyalgia for adults Treatment of MDD for adults MDD for Adults MDD for Adults (18+) Form Tabs (12.5,25,50 and 100mg) ER Capsule (20, 40,80, and 120mg) Tabs 5mg, 10mg, 20mg Tabs 10mg, 20mg, 40mg Classification Not controlled, pregnancy C Not controlled, pregnancy C Not controlled, pregnancy C Not controlled, pregnancy C Mechanism of SNRI(5HT:NE=1.6:1) SNRI (5HT:NE=1:2) SERT inhibitor, 5HT1a agonist, Selective serotonin reuptake Action 5ht3 antagonist, inhibitor, serotonergic receptor partial agonist activity Recommended 12.5 mg PO daily, then 12.5 mg PO BID 20mg PO daily x2 days, then 40mg 5-10mg PO daily, increased as 10mg PO daily for seven days, Dosing X2 days, then 25mg PO BID X4days, then daily. Titrate increments of 40mg q2 tolerated up to 20mg daily. 20mg PO daily for seven days 50mg PO BID. Max:200mg/day, days. Max: 120mg daily To discontinue, taper down to then 40mg PO daily Severe renal dz <=100mg/day Severe renal dz: <=40mg/day at least 10mg before d/c. Adverse Effects Nausea, vomiting, headaches, Nausea, vomiting, headaches, Nausea, vomiting, headaches, Diarrhea, nausea, insomnia constipation, insomnia, dizziness, constipation, insomnia, dizziness, constipation, insomnia, vomiting, dizziness, dry mouth, palpitation, flushing, blurred visions palpitation, flushing, blurred visions dizziness, palpitation, flushing, fatigue, abnormal dreams blurred visions Serious AEs Serotonin syndrome Serotonin syndrome Serotonin syndrome Serotonin syndrome HTN and tachycardia HTN and tachycardia HTN and tachycardia HTN and tachycardia Manic episode Manic episode Manic episode Manic episode Hyponatremia Hyponatremia Hyponatremia Hyponatremia Seizure Seizure Seizure Seizure Suicidal thoughts (black box) Suicidal thoughts (black Suicidal thoughts Suicidal thoughts box) (black box) (black box)
Contraindications Hypersensitivity Hypersensitive to this drug MAOI use within 14 days, MAO use within 14 days, MAOI use within 14 days MAOI use within 14 days methylene blue, linezolid methylene blue, linezolid Chronic hepatic dz/ ETOH abuse Chronic hepatic dz/ ETOH abuse use use ESRD ESRD Major Drug-Drug Risk of SS with Serotonergic Risk of SS with Serotonergic Risk of SS with Risk of SS with other interactions drugs drugs Serotonergic drugs serotonergic drugs Drugs metabolized by CYP3A4 Monitoring No serum drug level monitoring No serum drug level monitoring No serum drug level No serum drug level Baseline Creatinine, BP and HR Baseline Creatinine, BP and HR monitoring monitoring Half life 6-8 hrs Half life 12hrs Baseline hepatic function Baseline hepatic function Minimal metabolism via p450 Minimal metabolism via p450 Half life ~66 hours Half- life 25 hours (CYP3A4) (CYP3A4) Hepatic metabolism Hepatic metabolism through CYP450, CYP2D6 mainly through CYP3A4 Cost $395.42-$420.99 $389-421 $254-$460 $282-346 No generic available Generic is available No generic available No generic available