When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to levomilnacipran or milnacipran.

How to Use This Medicine:
Long Acting Capsule

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.
• Extended-release capsule: Swallow whole. Do not open, crush, or chew the capsule. Take it at the same time each day.
• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Do not use this medicine if you have used an MAOI within the past 14 days. Do not take an MAOI for at least 7 days after you stop this medicine.
• Some foods and medicines can affect how levomilnacipran works. Tell your doctor if you are also using the following:
  
  • Buspirone, fentanyl, lithium, ritonavir, St John's wort, tramadol, or a tryptophan supplement
  • A diuretic (water pill), medicine to treat an infection (clarithromycin, ketoconazole), a triptan medicine to treat migraine headaches, an NSAID pain or arthritis medicine (such as aspirin, diclofenac, ibuprofen, naproxen), or a blood thinner (such as warfarin)
• Do not drink alcohol while you are using this medicine. Alcohol may cause the medicine to be released too rapidly.
• Tell your doctor are using any medicine that makes you sleepy, such as allergy medicine or narcotic pain medicine.

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, glaucoma, heart disease, heart rhythm problems, high blood pressure, trouble urinating, or a history of seizures.
• For some children, teenagers, and young adults, this medicine may increase mental or emotional problems. This may lead to thoughts of suicide and violence. Talk with your doctor right away if you have any thoughts or behavior changes that concern you. Tell your doctor if you or anyone in your family has a history of bipolar disorder or suicide attempts.
• This medicine may cause the following problems:
  
  • Serotonin syndrome (more likely when used with certain other medicines)
  • Increased risk of bleeding problems
  • Low sodium levels in the blood
  • Increased blood pressure and heart rate
• This medicine may make you dizzy or drowsy. Do not drive or do anything that could be dangerous until you know how this medicine affects you.
• Do not stop using this medicine suddenly. Your doctor will need to slowly decrease your dose before you stop it completely.
• Call your doctor if your symptoms do not improve or if they get worse.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Anxiety, restlessness, fever, sweating, muscle spasms, nausea, vomiting, diarrhea, seeing or hearing things that are not there
• Confusion, weakness, and muscle twitching
• Difficult or painful urination
• Eye pain, vision changes, seeing halos around lights
• Fast or pounding heartbeat
• Feeling more excited or energetic than usual
• Headache, trouble concentrating, memory problems, unsteadiness
• Unusual behavior, thoughts of hurting yourself or others
• Unusual bleeding or bruising

If you notice these less serious side effects, talk with your doctor:

• Constipation, nausea
• Increased sweating
• Sexual problems

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088