Milnacipran Side Effects

Medically reviewed by Drugs.com. Last updated on Aug 9, 2024.

Applies to milnacipran: oral tablet.

Important warnings This medicine can cause some serious health issues

Oral route (tablet)

Milnacipran hydrochloride is a selective serotonin and norepinephrine reuptake inhibitor (SNRI), similar to some drugs used for the treatment of depression and other psychiatric disorders. Antidepressants increased the risk compared with placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies with major depressive disorder (MDD) and other psychiatric disorders.

Anyone considering the use of such drugs in a child, adolescent, or young adult must balance this risk with the clinical need.

Short term studies did not show an increase in the risk of suicidality with antidepressants compared with placebo in adults beyond age 24 years; there was a reduction in risk with antidepressants compared with placebo in adults aged 65 or older.

Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.

Patients of all ages who are started on milnacipran hydrochloride should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior.

Families and caregivers should be advised of the need for close observation and communication with the prescriber.

Milnacipran hydrochloride is not approved for use in the treatment of MDD.

Milnacipran hydrochloride is not approved for use in pediatric patients.

Serious side effects of milnacipran

Along with its needed effects, milnacipran may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking milnacipran:

More common side effects

• blurred vision
• body aches or pain
• chills
• cough
• difficulty with breathing
• dizziness
• ear congestion
• fast, irregular, pounding, or racing heartbeat or pulse
• fear or nervousness
• fever
• headache
• increased sweating
• loss of voice
• nasal congestion
• pounding in the ears
• runny nose
• slow or fast heartbeat
• sneezing
• sore throat
• unusual tiredness or weakness

Less common side effects

• back pain
• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• chest pain, discomfort, or tightness
• chills
• decrease in frequency of urination
• decrease in urine volume
• difficult or painful urination
• difficulty in passing urine (dribbling)
• frequent urination
• groin pain
• muscle aches
• pain or burning with urination
• shakiness in the legs, arms, hands, or feet
• swollen, tender prostate

Rare side effects

• bladder pain
• bloating or swelling of the face, arms, hands, lower legs, or feet
• bloody or cloudy urine
• bruise
• discouragement
• fall
• feeling sad or empty
• frequent urge to urinate
• full or bloated feeling
• heartburn
• increased or decreased weight
• irritability
• lack of appetite
• loss of interest or pleasure
• lower back or side pain
• pressure in the stomach
• rapid weight gain
• swelling of the stomach area
• tingling of the hands or feet
• tiredness
• trouble concentrating
• trouble sleeping
• unusual weight gain or loss
• vomiting

Incidence not known

• agitation
• black, tarry stools
• bleeding gums
• blistering, peeling, or loosening of the skin
• blood in the urine or stools
• coma
• confusion as to time, place, or person
• dark-colored urine
• delayed or inability to have an orgasm
• decreased interest in sexual intercourse
• decreased urine output
• diarrhea
• difficulty with swallowing
• general tiredness and weakness
• high fever
• holding false beliefs that cannot be changed by fact
• inability to have or keep an erection
• increased sweating
• increased thirst
• itching
• joint or muscle pain
• light-colored stools
• loss in sexual ability, desire, drive, or performance
• loss of balance control
• loss of consciousness
• mask-like face
• muscle cramps or spasms
• muscle pain or stiffness
• overactive reflexes
• pinpoint red spots on the skin
• poor coordination
• red skin lesions, often with a purple center
• red, irritated eyes
• restlessness
• seeing, hearing, or feeling things that are not there
• seizures
• severe muscle stiffness
• shuffling walk
• slowed movements
• slurred speech
• sores, ulcers, or white spots on the lips or in the mouth
• stiffness of the arms and legs
• sweating
• swelling of the face, ankles, fingers, or lower legs
• swollen glands
• talking or acting with excitement you cannot control
• tic-like (jerky) movements of the head, face, mouth, and neck
• tiredness
• trembling and shaking of the fingers and hands
• twitching
• unusual bleeding or bruising
• unusual excitement, nervousness, or restlessness
• unusually pale skin
• upper right abdominal or stomach pain
• weight gain
• yellow eyes and skin

Other side effects of milnacipran

Some side effects of milnacipran may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common side effects

• feeling of warmth
• headache, severe and throbbing
• redness of the face, neck, arms, and occasionally, upper chest
• sudden sweating

Less common side effects

• decreased appetite
• rash
• stomach pain
• swelling of the testes

Rare side effects

• acid or sour stomach
• belching
• bloated
• change in taste
• excess air or gas in the stomach or intestines
• full feeling
• heartburn
• indigestion
• irritability
• loss of taste
• night sweats
• passing gas
• sleepiness or unusual drowsiness
• stomach discomfort or upset

Incidence not known

• swelling of the breasts or unusual milk production
• unexpected or excess milk flow from the breasts

For healthcare professionals

Applies to milnacipran: oral tablet.

General adverse events

The most commonly reported side effects were nausea, constipation, headache, dizziness, insomnia, and hot flush.^[Ref]

Gastrointestinal

• Very common (10% or more): Nausea (up to 39%), constipation (up to 16%)
• Common (1% to 10%): Vomiting, dry mouth, abdominal pain/upper abdominal pain, diarrhea, dyspepsia, gastroesophageal reflux disease, flatulence, abdominal distension
• Uncommon (0.1% to 1%): Gastritis, stomatitis, hemorrhoids
• Postmarketing reports: Acute pancreatitis^[Ref]

Nervous system

• Very common (10% or more): Headache (up to 19%), dizziness (up to 11%)
• Common (1% to 10%): Migraine, paresthesia, tremor, tension headache, hypoesthesia, dysesthesia, somnolence, dysgeusia, convulsions (including grand mal), loss of consciousness, Parkinsonism, memory impairment
• Uncommon (0.1% to 1%): Syncope, vertigo
• Rare (0.01% to 0.1%): Balance disorder, cerebrovascular accident
• Frequency not reported: Serotonin syndrome^[Ref]

Dermatologic

• Very common (10% or more): Hyperhidrosis (up to 14%)
• Common (1% to 10%): Rash, pruritus, night sweats
• Uncommon (0.1% to 1%): Urticaria
• Rare (0.01% to 0.1%): Photosensitivity reaction
• Postmarketing reports: Erythema multiforme, Stevens Johnson syndrome, ecchymosis/cutaneous or mucosal bleeding^[Ref]

Cardiovascular

• Very common (10% or more): Hot flush (up to 12%)
• Common (1% to 10%): Palpitations, hypertension, increased heart rate, increased blood pressure, tachycardia, chest pain, chest discomfort, flushing
• Uncommon (0.1% to 1%): Arrhythmia, extrasystoles, hypotension, orthostatic hypotension, Raynaud's phenomena
• Rare (0.01% to 0.1%): Acute coronary syndrome, angina pectoris
• Frequency not reported: Contusion, peripheral edema
• Postmarketing reports: Supraventricular tachycardia, hypertensive crisis^[Ref]

Psychiatric

• Very common (10% or more): Insomnia (up to 12%)
• Common (1% to 10%): Anxiety, depression, stress, irritability, agitation
• Uncommon (0.1% to 1%): Suicidal ideation, panic attack, confusion, hallucination, nightmares, decreased libido
• Frequency not reported: Physical dependence
• Postmarketing reports: Aggression, anger, delirium, homicidal ideation, elimination of psychomotor inhibition with suicidal risk, mood switch with episodes of mania, reactivation of delusions in patients with psychosis^[Ref]

Genitourinary

• Common (1% to 10%): Dysuria, ejaculation disorder, erectile dysfunction, ejaculation failure, prostatitis, scrotal pain, testicular pain, testicular swelling, urinary hesitation, urinary retention, urethral pain, decreased urine flow, cystitis, urinary tract infection
• Uncommon (0.1% to 1%): Pollakiuria, metrorrhagia
• Rare (0.01% to 0.1%): Amenorrhea^[Ref]

Other

• Common (1% to 10%): Chills, pyrexia, fatigue, fall, pain
• Uncommon (0.1% to 1%): Tinnitus, feeling of body temperature change^[Ref]

Musculoskeletal

• Common (1% to 10%): Back pain, fibromyalgia, muscle spasms, arthralgia, pain in extremity
• Postmarketing reports: Rhabdomyolysis^[Ref]

Respiratory

• Common (1% to 10%): Upper respiratory tract infection, dyspnea, sinusitis, nasopharyngitis
• Uncommon (0.1% to 1%): Dyspnea
• Rare (0.01% to 0.1%): Epistaxis^[Ref]

Metabolic

• Common (1% to 10%): Decreased or increased weight, hypercholesterolemia, decreased appetite
• Postmarketing reports: Hyponatremia, anorexia^[Ref]

Ocular

• Common (1% to 10%): Blurred vision
• Uncommon (0.1% to 1%): Dry eye, mydriasis, reduced visual acuity
• Postmarketing reports: Accommodation disorder^[Ref]

Immunologic

• Common (1% to 10%): Influenza^[Ref]

Hepatic

• Uncommon (0.1% to 1%): Increased hepatic enzymes
• Rare (0.01% to 0.1%): Hepatitis
• Postmarketing reports: Cytolytic hepatitis^[Ref]

Hypersensitivity

• Uncommon (0.1% to 1%): Hypersensitivity^[Ref]

Renal

• Frequency not reported: Cystitis
• Postmarketing reports: Acute renal failure^[Ref]

Hematologic

• Postmarketing reports: Leukopenia, neutropenia, thrombocytopenia^[Ref]

Endocrine

• Postmarketing reports: Hyperprolactinemia, galactorrhea^[Ref]

Further information

Milnacipran side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

Medical Disclaimer