Milnacipran Dosage
This dosage information may not include all the information needed to use Milnacipran safely and effectively. See additional information for Milnacipran.
The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.
Usual Adult Dose for:
Usual Pediatric Dose for:
Additional dosage information:
Usual Adult Dose for Fibromyalgia
Dosing should be titrated according to the following schedule:
Initial dose on day 1: 12.5 mg once
Days 2 and 3: 12.5 mg twice daily
Days 4 through 7: 25 mg twice daily
After day 7: 50 mg twice daily
Recommended maintenance dose: 50 mg twice daily
Based on individual patient response, the dose may be increased to 100 mg twice daily. Doses above 200 mg/day have not been studied.
Milnacipran should be tapered and not abruptly discontinued after extended use.
Milnacipran may be given orally with or without food. However, taking milnacipran with food may improve the tolerability of the drug.
Usual Pediatric Dose for Fibromyalgia
17 years and older:
Dosing should be titrated according to the following schedule:
Initial dose on day 1: 12.5 mg once
Days 2 and 3: 12.5 mg twice daily
Days 4 through 7: 25 mg twice daily
After day 7: 50 mg twice daily
Recommended maintenance dose: 50 mg twice daily
Based on individual patient response, the dose may be increased to 100 mg twice daily. Doses above 200 mg/day have not been studied.
Milnacipran should be tapered and not abruptly discontinued after extended use.
Milnacipran may be given orally with or without food. However, taking milnacipran with food may improve the tolerability of the drug.
Renal Dose Adjustments
No dosage adjustment is necessary in patients with mild renal impairment. Milnacipran should be used with caution in patients with moderate renal impairment. For patients with severe renal impairment (indicated by an estimated creatinine clearance of 5 to 29 mL/min), the maintenance dose should be reduced by 50% to 25 mg twice daily. Based on individual patient response, the dose may be increased to 50 mg twice daily. Milnacipran is not recommended for patients with end-stage renal disease.
Liver Dose Adjustments
No dosage adjustment is necessary for patients with hepatic impairment. Caution is recommended when milnacipran is used in patients with severe hepatic impairment.
Dose Adjustments
Dosage adjustment based on gender is not necessary.
Precautions
Withdrawal symptoms have been observed in clinical trials following discontinuation of milnacipran. Patients should be monitored for these symptoms when discontinuing treatment. Milnacipran should be tapered and not abruptly discontinued after extended use.
In controlled clinical studies of milnacipran, 402 patients were 60 years or older and no overall differences in safety and efficacy were observed between these patients and younger patients. In view of the predominant excretion of unchanged milnacipran via kidneys and the expected decrease in renal function with age, renal function should be considered prior to use of milnacipran in the elderly. No dosage adjustment is necessary based on age unless renal function is severely impaired.
SNRIs, SSRIs, and milnacipran, have been associated with cases of clinically significant hyponatremia in elderly patients, who may be at greater risk for this adverse event.
At least 14 days should elapse between discontinuation of a MAOI and initiation of therapy with milnacipran. In addition, at least 5 days should be allowed after stopping milnacipran before starting a MAOI.
Dialysis
Milnacipran is not recommended for patients with end-stage renal disease.
