Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

1. Savella

Descriptions

Milnacipran is used to treat a condition called fibromyalgia, which causes muscle pain and stiffness. It belongs to a group of medicines known as selective serotonin and norepinephrine reuptake inhibitors (SSNRIs). These medicines work by increasing the activity of certain chemicals in the brain called serotonin and norepinephrine.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

• Tablet

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of milnacipran in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of milnacipran in the elderly. However, elderly patients are more likely to have hyponatremia (low sodium in the blood) and age-related kidney problems, which may require an adjustment in the dose for patients receiving milnacipran.

Breastfeeding

Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using this medicine.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Isocarboxazid
• Linezolid
• Methylene Blue
• Metoclopramide
• Ozanimod
• Phenelzine
• Procarbazine
• Rasagiline
• Safinamide
• Selegiline
• Tranylcypromine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Abciximab
• Aceclofenac
• Acemetacin
• Acenocoumarol
• Alfentanil
• Almotriptan
• Amifampridine
• Amineptine
• Amitriptyline
• Amitriptylinoxide
• Amoxapine
• Amphetamine
• Amtolmetin Guacil
• Anagrelide
• Anileridine
• Apixaban
• Ardeparin
• Argatroban
• Aspirin
• Avitriptan
• Bemiparin
• Benperidol
• Benzhydrocodone
• Benzphetamine
• Betrixaban
• Bivalirudin
• Bromfenac
• Brompheniramine
• Bufexamac
• Buprenorphine
• Bupropion
• Buspirone
• Butorphanol
• Cangrelor
• Carbamazepine
• Celecoxib
• Certoparin
• Chlorpheniramine
• Choline Salicylate
• Cilostazol
• Citalopram
• Clomipramine
• Clonixin
• Clopidogrel
• Cocaine
• Codeine
• Cyclobenzaprine
• Dabigatran Etexilate
• Dalteparin
• Danaparoid
• Desipramine
• Desirudin
• Desvenlafaxine
• Dexibuprofen
• Dexketoprofen
• Dextroamphetamine
• Dextromethorphan
• Dibenzepin
• Diclofenac
• Difenoxin
• Diflunisal
• Digoxin
• Dihydrocodeine
• Diphenoxylate
• Dipyridamole
• Dipyrone
• Dolasetron
• Donepezil
• Doxepin
• Droxicam
• Duloxetine
• Edoxaban
• Eletriptan
• Enoxaparin
• Epinephrine
• Epoprostenol
• Eptifibatide
• Escitalopram
• Ethylmorphine
• Etodolac
• Etofenamate
• Etoricoxib
• Felbinac
• Fenfluramine
• Fenoprofen
• Fentanyl
• Fepradinol
• Feprazone
• Floctafenine
• Fluconazole
• Flufenamic Acid
• Fluoxetine
• Flurbiprofen
• Fluvoxamine
• Fondaparinux
• Frovatriptan
• Gepirone
• Granisetron
• Heparin
• Hydrocodone
• Hydromorphone
• Hydroxyamphetamine
• Hydroxytryptophan
• Ibuprofen
• Iloprost
• Imipramine
• Indomethacin
• Iobenguane I 123
• Iobenguane I 131
• Ketobemidone
• Ketoprofen
• Ketorolac
• Lasmiditan
• Lepirudin
• Levoketoconazole
• Levomilnacipran
• Levorphanol
• Lisdexamfetamine
• Lithium
• Lofepramine
• Lorcaserin
• Lornoxicam
• Loxoprofen
• Lumiracoxib
• Meclofenamate
• Mefenamic Acid
• Melitracen
• Meloxicam
• Meperidine
• Metaxalone
• Methadone
• Methamphetamine
• Methotrexate
• Mirtazapine
• Morniflumate
• Morphine
• Morphine Sulfate Liposome
• Nabumetone
• Nadroparin
• Nalbuphine
• Naproxen
• Naratriptan
• Nefazodone
• Nepafenac
• Nicomorphine
• Niflumic Acid
• Nimesulide
• Nimesulide Beta Cyclodextrin
• Norepinephrine
• Nortriptyline
• Oliceridine
• Ondansetron
• Opipramol
• Opium
• Opium Alkaloids
• Oxaprozin
• Oxycodone
• Oxymorphone
• Oxyphenbutazone
• Palonosetron
• Papaveretum
• Parecoxib
• Paregoric
• Parnaparin
• Paroxetine
• Pentazocine
• Phenindione
• Phenprocoumon
• Phenylbutazone
• Piketoprofen
• Piritramide
• Piroxicam
• Pranoprofen
• Prasugrel
• Proglumetacin
• Propyphenazone
• Proquazone
• Protein C
• Protriptyline
• Remifentanil
• Reviparin
• Rivaroxaban
• Rizatriptan
• Rofecoxib
• Salicylic Acid
• Salsalate
• Selexipag
• Sertraline
• Sibutramine
• Sodium Salicylate
• St John's Wort
• Sufentanil
• Sulfinpyrazone
• Sulindac
• Sulodexide
• Sumatriptan
• Tapentadol
• Tenoxicam
• Tianeptine
• Tiaprofenic Acid
• Ticagrelor
• Ticlopidine
• Tilidine
• Tinzaparin
• Tirofiban
• Tolfenamic Acid
• Tolmetin
• Tramadol
• Trazodone
• Treprostinil
• Trimipramine
• Tryptophan
• Valdecoxib
• Venlafaxine
• Vilazodone
• Vorapaxar
• Vortioxetine
• Warfarin
• Ziprasidone
• Zolmitriptan

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

• Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol abuse, or history of or
• Bleeding problems or
• Depression, history of or
• Enlarged prostate or
• Glaucoma, angle-closure or
• Heart disease or
• Heart rhythm problems (eg, tachyarrhythmia) or
• Hypertension (high blood pressure) or
• Hyponatremia (low sodium in the blood) or
• Liver disease or
• Mania, history of or
• Painful or difficult urination, history of or
• Seizures, history of or
• Urinary tract blockage—Use with caution. May make these conditions worse.

• Kidney disease, end-stage—Use is not recommended in patients with this condition.

• Kidney disease, moderate or severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use

Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

You may take this medicine with or without food.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):
  • For treatment of fibromyalgia:
    • Adults—At first, 12.5 milligrams (mg) once a day on Day 1. 12.5 mg 2 times a day on Days 2 to 3. 25 mg 2 times a day on Days 4 to 7. 50 mg 2 times a day after Day 7. Your doctor may adjust your dose as needed. However, the dose is usually not more than 200 mg per day.
    • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions

It is important that your doctor check your progress at regular visits to allow for changes in your dose and to help reduce any side effects. Blood and urine tests may be needed to check for any unwanted effects.

Milnacipran may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Do not take this medicine during 14 days after stopping a monoamine oxidase inhibitor (MAOI) (eg, isocarboxazid [Marplan®], linezolid [Zyvox®], methylene blue injection, phenelzine [Nardil®], selegiline [Eldepryl®], or tranylcypromine [Parnate®]). Do not take an MAO inhibitor for at least 5 days after stopping milnacipran. Talk to your doctor about this if you have questions.

Make sure your doctor knows if you are also using aspirin, NSAIDs (eg, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Motrin®), or a blood thinner (eg, warfarin, Coumadin®). Milnacipran may increase your risk of bleeding problems when taken together with these medicines.

This medicine may cause a serious condition called serotonin syndrome when taken with certain medicines such as St. John's wort, buspirone, fentanyl, lithium, tryptophan, amphetamines, other medicines to treat depression, or some pain or migraine medicines (eg, rizatriptan [Maxalt®], sumatriptan [Imitrex®], tramadol [Ultram®], or zolmitriptan [Zomig®]. Check with your doctor first before taking any other medicines. Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there.

You will also need to have your blood pressure and pulse measured before starting and while you are using this medicine. If you notice any change to your recommended blood pressure or pulse rate, call your doctor right away. If you have questions about this, talk to your doctor.

Check with your doctor right away if you have clay-colored stools, dark urine, decreased appetite, fever, headache, itching, loss of appetite, nausea and vomiting, skin rash, stomach pain or tenderness, swelling of the feet or lower legs, unusual tiredness or weakness, or yellow eyes or skin. These may be symptoms of a serious liver problem.

Avoid drinking alcohol while you are using this medicine.

This medicine may cause some people to become less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who are taking diuretic medicines for high blood pressure, or those who have decreased amounts of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have confusion, headache, memory problems, trouble concentrating, weakness, or feel unsteady when standing.

Do not stop using this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely to decrease the chance of side effects, including actions that are out of control, agitation, anxiety, confusion, continuing ringing or buzzing or other unexplained noise in the ears, dizziness, headache, hearing loss, irritability, nervousness, seizures, talking, feeling, and acting with excitement, trouble sleeping, or unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness.

Check with your doctor right away if you have decreased interest in sexual intercourse, delayed or inability to have and orgasm in women, inability to have or keep an erection in men, or loss in sexual ability, desire, drive, or performance. These could be symptoms of sexual dysfunction.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

Side Effects

Along with its needed effects, a medicine 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:

More common

1. Blurred vision
2. body aches or pain
3. chills
4. cough
5. difficulty with breathing
6. dizziness
7. ear congestion
8. fast, irregular, pounding, or racing heartbeat or pulse
9. fear or nervousness
10. fever
11. headache
12. increased sweating
13. loss of voice
14. nasal congestion
15. pounding in the ears
16. runny nose
17. slow or fast heartbeat
18. sneezing
19. sore throat
20. unusual tiredness or weakness

Less common

1. Back pain
2. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
3. chest pain, discomfort, or tightness
4. chills
5. decrease in frequency of urination
6. decrease in urine volume
7. difficult or painful urination
8. difficulty in passing urine (dribbling)
9. frequent urination
10. groin pain
11. muscle aches
12. pain or burning with urination
13. shakiness in the legs, arms, hands, or feet
14. swollen, tender prostate

Rare

1. Bladder pain
2. bloating or swelling of the face, arms, hands, lower legs, or feet
3. bloody or cloudy urine
4. bruise
5. discouragement
6. fall
7. feeling sad or empty
8. frequent urge to urinate
9. full or bloated feeling
10. heartburn
11. increased or decreased weight
12. irritability
13. lack of appetite
14. loss of interest or pleasure
15. lower back or side pain
16. pressure in the stomach
17. rapid weight gain
18. swelling of the stomach area
19. tingling of the hands or feet
20. tiredness
21. trouble concentrating
22. trouble sleeping
23. unusual weight gain or loss
24. vomiting

Incidence not known

1. Agitation
2. black, tarry stools
3. bleeding gums
4. blistering, peeling, or loosening of the skin
5. blood in the urine or stools
6. coma
7. confusion as to time, place, or person
8. dark-colored urine
9. delayed or inability to have an orgasm
10. decreased interest in sexual intercourse
11. decreased urine output
12. diarrhea
13. difficulty with swallowing
14. general tiredness and weakness
15. high fever
16. holding false beliefs that cannot be changed by fact
17. inability to have or keep an erection
18. increased sweating
19. increased thirst
20. itching
21. joint or muscle pain
22. light-colored stools
23. loss in sexual ability, desire, drive, or performance
24. loss of balance control
25. loss of consciousness
26. mask-like face
27. muscle cramps or spasms
28. muscle pain or stiffness
29. overactive reflexes
30. pinpoint red spots on the skin
31. poor coordination
32. red skin lesions, often with a purple center
33. red, irritated eyes
34. restlessness
35. seeing, hearing, or feeling things that are not there
36. seizures
37. severe muscle stiffness
38. shuffling walk
39. slowed movements
40. slurred speech
41. sores, ulcers, or white spots on the lips or in the mouth
42. stiffness of the arms and legs
43. sweating
44. swelling of the face, ankles, fingers, or lower legs
45. swollen glands
46. talking or acting with excitement you cannot control
47. tic-like (jerky) movements of the head, face, mouth, and neck
48. tiredness
49. trembling and shaking of the fingers and hands
50. twitching
51. unusual bleeding or bruising
52. unusual excitement, nervousness, or restlessness
53. unusually pale skin
54. upper right abdominal or stomach pain
55. weight gain
56. yellow eyes and skin

Some side effects 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

1. Feeling of warmth
2. headache, severe and throbbing
3. redness of the face, neck, arms, and occasionally, upper chest
4. sudden sweating

Less common

1. Decreased appetite
2. rash
3. stomach pain
4. swelling of the testes

Rare

1. Acid or sour stomach
2. belching
3. bloated
4. change in taste
5. excess air or gas in the stomach or intestines
6. full feeling
7. heartburn
8. indigestion
9. irritability
10. loss of taste
11. night sweats
12. passing gas
13. sleepiness or unusual drowsiness
14. stomach discomfort or upset

Incidence not known

1. Swelling of the breasts or unusual milk production
2. unexpected or excess milk flow from the breasts

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: April 01, 2024

Original article: https://www.mayoclinic.org/drugs-supplements/milnacipran-oral-route/before-using/drg-20072479