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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, buproprion, 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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