| Major Depressive Disorder
Fetzima vs Effexor XR
Side-by-side clinical, coverage, and cost comparison for major depressive disorder.Deep comparison between: Fetzima vs Effexor with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsEffexor has a higher rate of injection site reactions vs Fetzima based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Effexor but not Fetzima, including UnitedHealthcare
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Category
Fetzima
Effexor
At A Glance
Oral
Once daily
SNRI
Oral
Daily
SNRI
Indications
- Major Depressive Disorder
- Major Depressive Disorder
- Generalized Anxiety Disorder
- Phobia, Social
- Panic Disorder
Dosing
Major Depressive Disorder Initiate at 20 mg once daily for 2 days, then increase to 40 mg once daily; may increase in 40 mg increments at intervals of 2 or more days; max 120 mg once daily, oral, with or without food.
Renal Impairment Severe (CrCl 15-29 mL/min): max 40 mg once daily; moderate (CrCl 30-59 mL/min): max 80 mg once daily; ESRD: not recommended.
Major Depressive Disorder Starting dose 37.5-75 mg/day; target 75 mg/day; max 225 mg/day; administered once daily with food.
Generalized Anxiety Disorder Starting dose 37.5-75 mg/day; target 75 mg/day; max 225 mg/day; administered once daily with food.
Phobia, Social Recommended dose 75 mg/day; administered once daily with food; no evidence that higher doses confer additional benefit.
Panic Disorder Starting dose 37.5 mg/day for 7 days, then 75 mg/day; max 225 mg/day; administered once daily with food.
Contraindications
- Hypersensitivity to levomilnacipran, milnacipran HCl, or any excipient in the formulation
- Concomitant use with MAOIs intended to treat psychiatric disorders, or within 7 days of stopping FETZIMA
- Use of FETZIMA within 14 days of stopping an MAOI intended to treat psychiatric disorders
- Concomitant use with linezolid or intravenous methylene blue
- Known hypersensitivity to venlafaxine hydrochloride, desvenlafaxine succinate, or any excipients in the formulation
- Concomitant use with MAOIs (including linezolid and intravenous methylene blue), or within 14 days of stopping an MAOI antidepressant, due to risk of serotonin syndrome
Adverse Reactions
Most common (>=5%) Nausea, constipation, hyperhidrosis, heart rate increased, erectile dysfunction, ejaculation disorder, tachycardia, vomiting, palpitations
Serious Suicidal thoughts and behaviors, serotonin syndrome, elevated blood pressure, elevated heart rate, increased risk of bleeding, angle closure glaucoma, urinary hesitation or retention, activation of mania/hypomania, seizure, discontinuation syndrome, hyponatremia, sexual dysfunction
Postmarketing Takotsubo cardiomyopathy, anosmia, hyposmia
Most common (>=5%) Nausea, somnolence, dry mouth, sweating, abnormal ejaculation, anorexia, constipation, impotence, decreased libido
Serious Serotonin syndrome, elevated blood pressure, increased risk of bleeding, angle-closure glaucoma, activation of mania/hypomania, discontinuation syndrome, seizure, hyponatremia, interstitial lung disease, eosinophilic pneumonia
Postmarketing Anaphylaxis, angioedema, QT prolongation, ventricular fibrillation, ventricular tachycardia (including torsade de pointes), takotsubo cardiomyopathy, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, neuroleptic malignant syndrome, rhabdomyolysis, hyponatremia, SIADH
Pharmacology
Levomilnacipran is a potent and selective serotonin and norepinephrine reuptake inhibitor (SNRI) that potentiates serotonin and norepinephrine neurotransmission in the central nervous system through inhibition of reuptake at their respective transporters, with no significant affinity for other receptors, ion channels, or transporters.
Venlafaxine is an SNRI whose antidepressant and anxiolytic effects are thought to be related to potentiation of serotonin and norepinephrine in the CNS through inhibition of their reuptake; it also weakly inhibits dopamine reuptake and has no significant affinity for muscarinic, H1-histaminergic, or alpha1-adrenergic receptors.
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Most Common Insurance
Anthem BCBS
Fetzima
- Covered on 5 commercial plans
- PA (3/12) · Step Therapy (11/12) · Qty limit (12/12)
Effexor
- Covered on 5 commercial plans
- PA (0/12) · Step Therapy (0/12) · Qty limit (12/12)
UnitedHealthcare
Fetzima
- Covered on 4 commercial plans
- PA (1/8) · Step Therapy (8/8) · Qty limit (6/8)
Effexor
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Humana
Fetzima
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (2/3)
Effexor
- Covered on 0 commercial plans
- PA (0/3) · Step Therapy (0/3) · Qty limit (2/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Fetzima.
No savings programs available for Effexor.
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Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.