Drug Interactions between digitoxin and milnacipran
This report displays the potential drug interactions for the following 2 drugs:
- digitoxin
- milnacipran
Interactions between your drugs
digitoxin milnacipran
Applies to: digitoxin and milnacipran
GENERALLY AVOID: Use of milnacipran concomitantly with digoxin may be associated with potentiation of adverse hemodynamic effects. Inhibition of norepinephrine and serotonin reuptake by milnacipran can lead to cardiovascular effects including sustained increases in blood pressure and heart rate. However, effects of milnacipran in patients with significant hypertension, arrhythmia, or cardiac disease have not been systematically evaluated. Postural hypotension and tachycardia have been reported in combination therapy with intravenously administered digoxin (1 mg). No pharmacokinetic interaction was observed between milnacipran (200 mg/day) and digoxin (0.2 mg/day Lanoxicaps) following multiple-dose administration to healthy subjects.
MANAGEMENT: Coadministration of milnacipran and intravenous digoxin should be avoided. Caution is advised during coadministration with oral digoxin therapy. Blood pressure and heart rate should be measured prior to initiating milnacipran and periodically throughout treatment. A dosage reduction or discontinuation should be considered in patients who experience a sustained increase in blood pressure or heart rate while receiving milnacipran.
References (1)
- (2009) "Product Information. Savella (milnacipran)." Forest Pharmaceuticals
Drug and food interactions
milnacipran food
Applies to: milnacipran
GENERALLY AVOID: Use of milnacipran in conjunction with chronic alcohol consumption may potentiate the risk of liver injury. Milnacipran alone can increase serum transaminase levels. In placebo-controlled fibromyalgia trials, increases in ALT were more frequently observed in patients treated with milnacipran 100 mg/day (6%) and 200 mg/day (7%) compared to patients treated with placebo (3%). One patient receiving milnacipran 100 mg/day (0.2%) had an increase in ALT greater than 5 times the upper limit of normal (ULN) but did not exceed 10 times the ULN. Increases in AST were also more frequently observed in patients treated with milnacipran 100 mg/day (3%) and 200 mg/day (5%) than in patients treated with placebo (2%). There have been reported cases of increased liver enzymes and severe liver injury, including fulminant hepatitis, from foreign postmarketing experience with milnacipran. Significant underlying clinical conditions and/or use of multiple concomitant medications were present in the cases of severe liver injury.
MANAGEMENT: Due to the risk of liver injury, patients prescribed milnacipran should be counseled to avoid excessive use of alcohol. Milnacipran should generally not be prescribed to patients with substantial alcohol use.
References (1)
- (2009) "Product Information. Savella (milnacipran)." Forest Pharmaceuticals
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Report options
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Check Interactions
To view an interaction report containing 4 (or more) medications, please sign in or create an account.
Save Interactions List
Sign in to your account to save this drug interaction list.