General Information of Drug (ID: DMV26S8)

Drug Name
Levomilnacipran
Synonyms
Fetzima; UNII-UGM0326TXX; Levomilnacipran HCl; 96847-54-0; UGM0326TXX; CHEMBL99946; F-2695; (1S,2R)-2-(aminomethyl)-N,N-diethyl-1-phenylcyclopropanecarboxamide; (1S,2R)-2-(aminomethyl)-N,N-diethyl-1-phenylcyclopropane-1-carboxamide; Levomilnacipran [USAN:INN]; Milnacipram; AC1OCEN8; F 2695; Levomilnacipran (USAN/INN); ZINC506; SCHEMBL1414867; GTPL7435; GJJFMKBJSRMPLA-DZGCQCFKSA-N; CHEBI:136040; BDBM50032379; SB17447; DB08918; f2-695; D10072
Indication
Disease Entry ICD 11 Status REF
Fibromyalgia MG30.01 Approved [1], [2]
Drug Type
Small molecular drug
Structure
3D MOL 2D MOL
#Ro5 Violations (Lipinski): 0 Molecular Weight (mw) 246.35
Topological Polar Surface Area (xlogp) 1.4
Rotatable Bond Count (rotbonds) 5
Hydrogen Bond Donor Count (hbonddonor) 1
Hydrogen Bond Acceptor Count (hbondacc) 2
ADMET Property
Clearance
The total clearance of drug is 21-29 L/h [3]
Half-life
The concentration or amount of drug in body reduced by one-half in 12 hours [4]
Metabolism
The drug is metabolized via the hepatic [5]
Vd
The volume of distribution (Vd) of drug is 387-473 L [3]
Chemical Identifiers
Formula
C15H22N2O
IUPAC Name
(1S,2R)-2-(aminomethyl)-N,N-diethyl-1-phenylcyclopropane-1-carboxamide
Canonical SMILES
CCN(CC)C(=O)[C@]1(C[C@H]1CN)C2=CC=CC=C2
InChI
InChI=1S/C15H22N2O/c1-3-17(4-2)14(18)15(10-13(15)11-16)12-8-6-5-7-9-12/h5-9,13H,3-4,10-11,16H2,1-2H3/t13-,15+/m0/s1
InChIKey
GJJFMKBJSRMPLA-DZGCQCFKSA-N
Cross-matching ID
PubChem CID
6917779
ChEBI ID
CHEBI:136040
CAS Number
96847-54-0
DrugBank ID
DB08918
TTD ID
D02XOK
VARIDT ID
DR00049
INTEDE ID
DR0945
ACDINA ID
D00362

Molecular Interaction Atlas of This Drug


Drug Therapeutic Target (DTT)
DTT Name DTT ID UniProt ID MOA REF
Norepinephrine transporter (NET) TTAWNKZ SC6A2_HUMAN Modulator [2]
Serotonin transporter (SERT) TT3ROYC SC6A4_HUMAN Modulator [2]

Drug Transporter (DTP)
DTP Name DTP ID UniProt ID MOA REF
P-glycoprotein 1 (ABCB1) DTUGYRD MDR1_HUMAN Substrate [6]

Drug-Metabolizing Enzyme (DME)
DME Name DME ID UniProt ID MOA REF
Cytochrome P450 3A4 (CYP3A4)
Main DME
DE4LYSA CP3A4_HUMAN Substrate []
Cytochrome P450 2D6 (CYP2D6) DECB0K3 CP2D6_HUMAN Substrate []
Mephenytoin 4-hydroxylase (CYP2C19) DEGTFWK CP2CJ_HUMAN Substrate []
Cytochrome P450 2C8 (CYP2C8) DES5XRU CP2C8_HUMAN Substrate [7]
Cytochrome P450 2J2 (CYP2J2) DERSX5P CP2J2_HUMAN Substrate []
Molecular Interaction Atlas (MIA) Jump to Detail Molecular Interaction Atlas of This Drug

Molecular Expression Atlas of This Drug

The Studied Disease Fibromyalgia
ICD Disease Classification MG30.01
Molecule Name Molecule Type Gene Name p-value Fold-Change Z-score
Serotonin transporter (SERT) DTT SLC6A4 8.76E-01 7.18E-05 6.19E-04
P-glycoprotein 1 (ABCB1) DTP P-GP 6.54E-01 1.95E-01 4.04E-01
Cytochrome P450 2C8 (CYP2C8) DME CYP2C8 5.57E-01 -7.89E-02 -7.93E-01
Molecular Expression Atlas (MEA) Jump to Detail Molecular Expression Atlas of This Drug

Drug-Drug Interaction (DDI) Information of This Drug

Coadministration of a Drug Treating the Disease Different from Levomilnacipran (Comorbidity)
DDI Drug Name DDI Drug ID Severity Mechanism Comorbidity REF
Methylene blue DMJAPE7 Major Additive serotonergic effects by the combination of Levomilnacipran and Methylene blue. Acquired methaemoglobinaemia [3A93] [34]
Oliceridine DM6MDCF Moderate Additive serotonergic effects by the combination of Levomilnacipran and Oliceridine. Acute pain [MG31] [35]
Inotersen DMJ93CT Moderate Increased risk of bleeding by the combination of Levomilnacipran and Inotersen. Amyloidosis [5D00] [36]
Levalbuterol DM5YBO1 Moderate Increased risk of rapid heart rate by the combination of Levomilnacipran and Levalbuterol. Asthma [CA23] [37]
Olodaterol DM62B78 Moderate Increased risk of rapid heart rate by the combination of Levomilnacipran and Olodaterol. Chronic obstructive pulmonary disease [CA22] [37]
Vilanterol DMF5EK1 Moderate Increased risk of rapid heart rate by the combination of Levomilnacipran and Vilanterol. Chronic obstructive pulmonary disease [CA22] [37]
Vortioxetine DM6F1PU Major Additive serotonergic effects by the combination of Levomilnacipran and Vortioxetine. Depression [6A70-6A7Z] [38]
Eslicarbazepine DMZREFQ Moderate Increased risk of hyponatremia by the combination of Levomilnacipran and Eslicarbazepine. Epilepsy/seizure [8A61-8A6Z] [39]
Tazemetostat DMWP1BH Moderate Increased risk of bleeding by the combination of Levomilnacipran and Tazemetostat. Follicular lymphoma [2A80] [36]
Avapritinib DMK2GZX Moderate Increased risk of bleeding by the combination of Levomilnacipran and Avapritinib. Gastrointestinal stromal tumour [2B5B] [36]
Cobicistat DM6L4H2 Major Decreased metabolism of Levomilnacipran caused by Cobicistat mediated inhibition of CYP450 enzyme. Human immunodeficiency virus disease [1C60-1C62] [40]
Polyethylene glycol DM4I1JP Moderate Increased risk of lowers seizure threshold by the combination of Levomilnacipran and Polyethylene glycol. Irritable bowel syndrome [DD91] [41]
Ceritinib DMB920Z Major Decreased metabolism of Levomilnacipran caused by Ceritinib mediated inhibition of CYP450 enzyme. Lung cancer [2C25] [40]
Idelalisib DM602WT Major Decreased metabolism of Levomilnacipran caused by Idelalisib mediated inhibition of CYP450 enzyme. Mature B-cell leukaemia [2A82] [40]
Ibrutinib DMHZCPO Moderate Increased risk of bleeding by the combination of Levomilnacipran and Ibrutinib. Mature B-cell lymphoma [2A85] [36]
Allopregnanolone DMNLHAC Moderate Additive CNS depression effects by the combination of Levomilnacipran and Allopregnanolone. Mental/behavioural/neurodevelopmental disorder [6E20-6E8Z] [42]
Ozanimod DMT6AM2 Moderate Additive serotonergic effects by the combination of Levomilnacipran and Ozanimod. Multiple sclerosis [8A40] [43]
Fedratinib DM4ZBK6 Moderate Increased risk of bleeding by the combination of Levomilnacipran and Fedratinib. Myeloproliferative neoplasm [2A20] [44]
Vorapaxar DMA16BR Moderate Increased risk of bleeding by the combination of Levomilnacipran and Vorapaxar. Myocardial infarction [BA41-BA43] [36]
Choline salicylate DM8P137 Moderate Increased risk of bleeding by the combination of Levomilnacipran and Choline salicylate. Postoperative inflammation [1A00-CA43] [36]
Betrixaban DM2C4RF Moderate Increased risk of bleeding by the combination of Levomilnacipran and Betrixaban. Venous thromboembolism [BD72] [36]
⏷ Show the Full List of 21 DDI Information of This Drug

Drug Inactive Ingredient(s) (DIG) and Formulation(s) of This Drug

DIG
DIG Name DIG ID PubChem CID Functional Classification
Eisenoxyd E00585 56841934 Colorant
Ferric hydroxide oxide yellow E00539 23320441 Colorant
Ferrosoferric oxide E00231 14789 Colorant
Povidone E00667 Not Available Binding agent; Coating agent; Disintegrant; Film/membrane-forming agent; Solubilizing agent; Suspending agent
Saccharose E00091 5988 Binding agent; Coating agent; Cryoprotectant; Diluent; Flavoring agent; Suspending agent; Viscosity-controlling agent
Talc E00520 16211421 Anticaking agent; Diluent; Glidant; lubricant
Titanium dioxide E00322 26042 Coating agent; Colorant; Opacifying agent
Triethyl citrate E00128 6506 Plasticizing agent; Solvent
⏷ Show the Full List of 8 Pharmaceutical Excipients of This Drug
Pharmaceutical Formulation
Formulation Name Drug Dosage Dosage Form Route
Levomilnacipran 120 mg capsule 120 mg 24 HR Extended Release Oral Capsule Oral
Levomilnacipran 20 mg capsule 20 mg 24 HR Extended Release Oral Capsule Oral
Levomilnacipran 40 mg capsule 40 mg 24 HR Extended Release Oral Capsule Oral
Levomilnacipran 80 mg capsule 80 mg 24 HR Extended Release Oral Capsule Oral
Jump to Detail Pharmaceutical Formulation Page of This Drug

References

1 URL: http://www.guidetopharmacology.org Nucleic Acids Res. 2015 Oct 12. pii: gkv1037. The IUPHAR/BPS Guide to PHARMACOLOGY in 2016: towards curated quantitative interactions between 1300 protein targets and 6000 ligands. (Ligand id: 7435).
2 Hughes B: 2009 FDA drug approvals. Nat Rev Drug Discov. 2010 Feb;9(2):89-92.
3 An FDA phase I clinical trial of quinacrine sterilization (QS). Int J Gynaecol Obstet. 2003 Oct;83 Suppl 2:S45-9.
4 Trend Analysis of a Database of Intravenous Pharmacokinetic Parameters in Humans for 1352 Drug Compounds
5 FDA approval: ado-trastuzumab emtansine for the treatment of patients with HER2-positive metastatic breast cancer. Clin Cancer Res. 2014 Sep 1;20(17):4436-41.
6 P-glycoprotein differentially affects escitalopram, levomilnacipran, vilazodone and vortioxetine transport at the mouse blood-brain barrier inivo. Neuropharmacology. 2016 Apr;103:104-11.
7 The role of levomilnacipran in the management of major depressive disorder: a comprehensive review. Curr Neuropharmacol. 2016;14(2):191-9.
8 Roles of cytochromes P450 1A2, 2A6, and 2C8 in 5-fluorouracil formation from tegafur, an anticancer prodrug, in human liver microsomes. Drug Metab Dispos. 2000 Dec;28(12):1457-63.
9 Role of cytochrome P450 2C8 in drug metabolism and interactions. Pharmacol Rev. 2016 Jan;68(1):168-241.
10 Summary of information on human CYP enzymes: human P450 metabolism data. Drug Metab Rev. 2002 Feb-May;34(1-2):83-448.
11 Differential expression and function of CYP2C isoforms in human intestine and liver. Pharmacogenetics. 2003 Sep;13(9):565-75.
12 Analysis of human cytochrome P450 2C8 substrate specificity using a substrate pharmacophore and site-directed mutants. Biochemistry. 2004 Dec 14;43(49):15379-92.
13 Interaction of sorafenib and cytochrome P450 isoenzymes in patients with advanced melanoma: a phase I/II pharmacokinetic interaction study. Cancer Chemother Pharmacol. 2011 Nov;68(5):1111-8.
14 PharmGKB summary: mycophenolic acid pathway. Pharmacogenet Genomics. 2014 Jan;24(1):73-9.
15 Possible involvement of multiple human cytochrome P450 isoforms in the liver metabolism of propofol. Br J Anaesth. 1998 Jun;80(6):788-95.
16 Human intestinal transporter database: QSAR modeling and virtual profiling of drug uptake, efflux and interactions. Pharm Res. 2013 Apr;30(4):996-1007.
17 MDR1 (ABCB1) G1199A (Ser400Asn) polymorphism alters transepithelial permeability and sensitivity to anticancer agents. Cancer Chemother Pharmacol. 2009 Jun;64(1):183-8.
18 Mammalian drug efflux transporters of the ATP binding cassette (ABC) family in multidrug resistance: A review of the past decade. Cancer Lett. 2016 Jan 1;370(1):153-64.
19 Folate transporter expression decreases in the human placenta throughout pregnancy and in pre-eclampsia. Pregnancy Hypertens. 2012 Apr;2(2):123-31.
20 Comparative studies on in vitro methods for evaluating in vivo function of MDR1 P-glycoprotein. Pharm Res. 2001 Dec;18(12):1660-8.
21 Antiestrogens and steroid hormones: substrates of the human P-glycoprotein. Biochem Pharmacol. 1994 Jul 19;48(2):287-92.
22 Association of genetic polymorphisms in the influx transporter SLCO1B3 and the efflux transporter ABCB1 with imatinib pharmacokinetics in patients with chronic myeloid leukemia. Ther Drug Monit. 2011 Apr;33(2):244-50.
23 Augmentation effect of combination therapy of aripiprazole and antidepressants on forced swimming test in mice. Psychopharmacology (Berl). 2009 Sep;206(1):97-107.
24 Treatment of comorbid pain with serotonin norepinephrine reuptake inhibitors. CNS Spectr. 2008 Jul;13(7 Suppl 11):22-6.
25 Invivo antioxidant status: a putative target of antidepressant action. Prog Neuropsychopharmacol Biol Psychiatry. 2009 Mar 17;33(2):220-8.
26 Differential involvement of the norepinephrine, serotonin and dopamine reuptake transporter proteins in cocaine-induced taste aversion. Pharmacol Biochem Behav. 2009 Jul;93(1):75-81.
27 Clinically relevant drug interactions with new generation antidepressants and antipsychotics. Ther Umsch. 2009 Jun;66(6):485-92.
28 2008 FDA drug approvals. Nat Rev Drug Discov. 2009 Feb;8(2):93-6.
29 Antidepressants suppress production of the Th1 cytokine interferon-gamma, independent of monoamine transporter blockade. Eur Neuropsychopharmacol. 2006 Oct;16(7):481-90.
30 Multi-target therapeutics: when the whole is greater than the sum of the parts. Drug Discov Today. 2007 Jan;12(1-2):34-42.
31 Drugs@FDA. U.S. Food and Drug Administration. U.S. Department of Health & Human Services.
32 Radium 223 dichloride for prostate cancer treatment. Drug Des Devel Ther. 2017 Sep 6;11:2643-2651.
33 Psychopharmacological treatment of dermatological patients--when simply talking does not help. J Dtsch Dermatol Ges. 2007 Dec;5(12):1101-6.
34 Boyer EW, Shannon M "The serotonin syndrome." N Engl J Med 352 (2005): 1112-20. [PMID: 15784664]
35 Vizcaychipi MP, Walker S, Palazzo M "Serotonin syndrome triggered by tramadol." Br J Anaesth 99 (2007): 919. [PMID: 18006535]
36 Alderman CP, Moritz CK, Ben-Tovim DI "Abnormal platelet aggregation associated with fluoxetine therapy." Ann Pharmacother 26 (1992): 1517-9. [PMID: 1482806]
37 Product Information. Cymbalta (duloxetine). Lilly, Eli and Company, Indianapolis, IN.
38 Achamallah NS "Visual hallucinations after combining fluoxetine and dextromethorphan ." Am J Psychiatry 149 (1992): 1406. [PMID: 1530079]
39 Belcastro V, Costa C, Striano P "Levetiracetam-associated hyponatremia." Seizure 17 (2008): 389-90. [PMID: 18584781]
40 Product Information. Fetzima (levomilnacipran). Forest Pharmaceuticals, St. Louis, MO.
41 Product Information. Suprep Bowel Prep Kit (magnesium/potassium/sodium sulfates). Braintree Laboratories, Braintree, MA.
42 Product Information. Zulresso (brexanolone). Sage Therapeutics, Inc., Cambridge, MA.
43 Alvine G, Black DW, Tsuang D "Case of delirium secondary to phenelzine/L-tryptophan combination." J Clin Psychiatry 51 (1990): 311. [PMID: 2365671]
44 Bannister SJ, Houser VP, Hulse JD, Kisicki JC, Rasmussen JG "Evaluation of the potential for interactions of paroxetine with diazepam, cimetidine, warfarin, and digoxin." Acta Psychiatr Scand Suppl 350 (1989): 102-6. [PMID: 2530759]