milnacipran, Savella

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical and Pharmacy Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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What is milnacipran, and how does it work (mechanism of action)?

Milnacipran is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) used for treating pain associated with fibromyalgia. It is similar to duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq). Milnacipran affects neurotransmitters, the chemicals that nerves within the brain make and release in order to communicate with one another. Neurotransmitters either travel across the space between nerves, attach to receptors on the surface of nearby nerves or they attach to receptors on the surface of the nerves that produced them. The neurotransmitters may be taken up by the nerve and released again (a process referred to as re-uptake).

Serotonin and norepinephrine are two neurotransmitters released by nerves in the brain. Milnacipran prevents the reuptake of serotonin and epinephrine by nerves after they have been released. Since uptake is an important mechanism for removing released neurotransmitters and terminating their actions on adjacent nerves, the reduced uptake caused by milnacipran increases the effect of serotonin and norepinephrine in the brain. The mechanism responsible for its effectiveness for treating fibromyalgia is not known but milnacipran action is thought to involve its effects on serotonin and norepinephrine in the brain. Milnacipran was approved by the FDA in January 2009.

What brand names are available for milnacipran?

Savella

Is milnacipran available as a generic drug?

GENERIC AVAILABLE: No

Do I need a prescription for milnacipran?

Yes

What are the side effects of milnacipran?

The most frequent side effects include: 

Other side effects include: 

Antidepressants may increase the risk of suicidal thinking and behavior in children and adolescents with depression. Patients who are started on milnacipran or another antidepressant should be observed closely for clinical worsening, suicidal thinking and behavior, or unusual behavior.

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Fibromyalgia Symptoms, Diagnosis & Treatment

What is the dosage for milnacipran?

The recommended starting dose is 12.5 mg once a day, then 12.5 mg every 12 hours for days 2 and 3, then 25 mg every 12 hours for days 4 to 7, then 100 mg twice a day thereafter.

  • The maximum dose is 200 mg per day.
  • It may be administered with or without food, but food improves the ability to tolerate this medication.
  • This drug has not been studied in the pediatric population (under age 18).

Which drugs or supplements interact with milnacipran?

Milnacipran should not be used in combination with a monoamine oxidase inhibitor (MAOI) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and selegiline (Eldepryl), or within 14 days of discontinuing the MAOI. At least 5 days should be allowed after stopping milnacipran before starting an MAOI. Combinations of SNRIs and MAOIs may lead to serious, sometimes fatal, reactions including very high body temperature, rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation progressing to delirium and coma. Similar reactions may occur if milnacipran is combined with antipsychotics, tricyclic antidepressants or other drugs that affect serotonin in the brain (for example, tryptophan and sumatriptan [Imitrex]).

Combining milnacipran with epinephrine or norepinephrine may lead to high blood pressure and abnormal heart beats because milnacipran increases epinephrine and norepinephrine.

Combining milnacipran with aspirin, nonsteroidal antiinflammatory drugs (NSAIDs), warfarin (Coumadin) or other drugs that are associated with bleeding may increase the risk of bleeding, because milnacipran is associated with bleeding.

Is milnacipran safe to take if I'm pregnant or breastfeeding?

Milnacipran is excreted in human breast milk. The effect of milnacipran on nursing infants is not known. Breastfeeding should probably be avoided while taking milnacipran.

What else should I know about milnacipran?

What preparations of milnacipran are available?

Tablets: 12.5, 25, 50, and 100 mg

How should I keep milnacipran stored?

Milnacipran should be stored at room temperature, 15 C to 30 C (59 F to 86 F).

Medically reviewed by John P. Cunha, DO, FACOEP

REFERENCE:

FDA Prescribing Information.

Last Editorial Review: 5/15/2017

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See more info: milnacipran on RxList
Reviewed on 5/15/2017
References
Medically reviewed by John P. Cunha, DO, FACOEP

REFERENCE:

FDA Prescribing Information.

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