Generic Name: milnacipran (mil NA si pran)
Brand Name: Savella
What is milnacipran?
Milnacipran affects certain chemicals in the brain called neurotransmitters. An abnormality in these chemicals is thought to be related to fibromyalgia (a medical condition that causes chronic pain in the muscles and joints). Milnacipran is not used to treat depression but it works similarly to how some antidepressants work.
Milnacipran is used to treat the chronic pain caused by fibromyalgia.
Milnacipran may also be used for purposes not listed in this medication guide.
What is the most important information I should know about milnacipran?
Do not use this medicine if you have used an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. After you stop taking milnacipran, you must wait at least 5 days before you start taking an MAOI.
Some young people have thoughts about suicide when first taking an antidepressant. Stay alert to changes in your mood or symptoms.
Milnacipran is not approved for use by anyone younger than 18 years old.
What should I discuss with my healthcare provider before taking milnacipran?
You should not use milnacipran if you are allergic to it.
Do not use milnacipran if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, tranylcypromine, and others. After you stop taking milnacipran, you must wait at least 5 days before you start taking an MAOI.
To make sure milnacipran is safe for you, tell your doctor if you have:
heart disease, high blood pressure;
seizures or epilepsy;
bipolar disorder (manic depression);
a bleeding or blood clotting disorder such as hemophilia;
low levels of sodium in your blood;
problems with urination;
if you take a blood thinner such as warfarin (Coumadin, Jantoven); or
if you drink alcohol.
Some young people have thoughts about suicide when first taking milnacipran. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Taking this medicine during pregnancy may cause serious lung problems or other complications in the baby. However, you may have a relapse of your symptoms if you stop taking milnacipran. Tell your doctor right away if you become pregnant. Do not start or stop taking this medicine during pregnancy without your doctor's advice.
If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of milnacipran on the baby.
Milnacipran can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Milnacipran should not be given to a child younger than 18 years old.
How should I take milnacipran?
Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.
You may take medicine with or without food, but food may help you tolerate the medicine better.
Your blood pressure and heart rate will need to be checked often.
Do not stop using milnacipran suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to safely stop using milnacipran.
Tell your doctor if the medicine seems to stop working as well in relieving your fibromyalgia pain.
Store at room temperature away from moisture and heat.
What happens if I miss a dose?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include extreme drowsiness, slow heart rate, weak pulse, fainting, and slow breathing (breathing may stop).
What should I avoid while taking milnacipran?
Avoid drinking alcohol.
Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with milnacipran may cause you to bruise or bleed easily.
Milnacipran may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Milnacipran side effects
Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have:
a light-headed feeling, like you might pass out;
pounding heartbeats or fluttering in your chest;
blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
little or no urinating;
easy bruising or bleeding (nosebleeds), or signs of stomach bleeding (bloody or tarry stools, coughing up blood);
manic episodes--racing thoughts, increased energy, unusual risk-taking behavior, extreme happiness, being irritable or talkative;
high levels of serotonin in the body--agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting;
low levels of sodium in the body--headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or
dangerously high blood pressure--severe headache, blurred vision, pounding in your neck or ears, nosebleed, anxiety, confusion, severe chest pain, shortness of breath, irregular heartbeats.
Some side effects may be more likely in older adults.
Common side effects may include:
nausea, vomiting, constipation;
increased sweating, flushing (warmth, redness, or tingly feeling);
sleep problems (insomnia); or
high blood pressure, pounding heartbeat.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)
Milnacipran dosing information
Usual Adult Dose for Fibromyalgia:
Maintenance dose: 50 mg orally 2 times a day
Maximum dose: 100 mg orally 2 times a day (200 mg orally per day)
-Dosing may be titrated according to the following schedule:
-Initial dose on day 1: 12.5 mg orally once
-Days 2 and 3: 12.5 mg orally 2 times a day
-Days 4 through 7: 25 mg orally 2 times a day
-After day 7: 50 mg orally 2 times a day
Use: Management of fibromyalgia
What other drugs will affect milnacipran?
Taking this medicine with other drugs that make you sleepy can worsen this effect. Ask your doctor before taking milnacipran with a sleeping pill, narcotic pain medicine, prescription cough medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Some medicines can interact with milnacipran and cause a serious condition called serotonin syndrome. Be sure your doctor knows if you also take medicine for depression, mental illness, Parkinson's disease, migraine headaches, ADHD, narcolepsy, serious infections, or prevention of nausea and vomiting. Ask your doctor before making any changes in how or when you take your medications.
Other drugs may interact with milnacipran, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.
More about milnacipran
- Side Effects
- During Pregnancy or Breastfeeding
- Dosage Information
- Drug Interactions
- Support Group
- En Español
- 302 Reviews – Add your own review/rating
- Drug class: serotonin-norepinephrine reuptake inhibitors
Other brands: Savella
Related treatment guides
Where can I get more information?
- Your doctor or pharmacist can provide more information about milnacipran.
- Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
- Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2012 Cerner Multum, Inc. Version: 5.01.
Last reviewed: January 09, 2017
Date modified: July 24, 2017