Lyrica (pregabalin) vs. Savella (milnacipran)

• Lyrica (pregabalin) and Savella (milnacipran) are used to treat pain associated with fibromyalgia.
• Lyrica is also used to treat neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia, and it us used in combination with other drugs to treat partial onset seizures in adults.
• Lyrica and Savella belong to different drug classes. Lyrica is an anti-epileptic drug (AED) and Savella is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) antidepressant.
• Side effects of Lyrica and Savella that are similar include dizziness, nausea, vomiting, constipation, and dry mouth.
• Side effects of Lyrica that are different from Savella include fatigue, drowsiness, fluid retention (edema), blurred vision, double vision, weight gain, abnormal gait, tremor, difficulty concentrating, increased appetite, gas, amnesia, disorientation, myoclonus (sudden, involuntary jerking of a muscle or muscle groups), heart failure, low blood pressure, reduced blood platelet counts, and increased blood creatinine kinase levels.
• Side effects of Savella that are different from Lyrica include headache, insomnia, flushing, excessive sweating, palpitations, increased heart rate, and high blood pressure.
• Withdrawal symptoms may occur if you suddenly stop taking Savella.

Lyrica (pregabalin) is an oral medication chemically related to gabapentin (Gralise, Neurontin) used to treat pain caused by neurologic diseases such as postherpetic neuralgia as well as seizures. It also is used to treat fibromyalgia.

Savella (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.

Lyrica

WARNING

• Antiepileptic medications have been associated with increased risk of suicidal thinking and behavior. Anyone considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidal thoughts, or unusual changes in behavior.

The most common side effects of Lyrica are

• dizziness,
• drowsiness,
• dry mouth (xerostomia),
• edema (accumulation of fluid),
• blurred vision,
• double vision (diplopia),
• weight gain,
• fatigue (tiredness),
• abnormal gait (ataxia),
• tremor, and
• difficulty concentrating.

Other side effects include

• constipation,
• increased appetite,
• nausea,
• flatulence,
• amnesia,
• disorientation,
• myoclonus (sudden, involuntary jerking of a muscle or muscle groups),
• heart failure,
• low blood pressure,
• vomiting,
• reduced blood platelet counts, and
• increased blood creatinine kinase levels.

Increased creatinine kinase can be a sign of muscle injury, and in clinical trials three patients experienced rhabdomyolysis (severe muscle injury). Therefore, patients should report unexplained muscle pain, tenderness or weakness to their doctors, especially if associated with fever and malaise (reduced well-being). Lyrica has rarely been associated with angioedema (swelling of the face, tongue, lips, and gums, throat and larynx).

Savella

The most frequent side effects include:

• nausea,
• headache,
• constipation,
• dizziness,
• insomnia,
• flushing,
• excessive sweating,
• vomiting,
• palpitations,
• increased heart rate,
• dry mouth, and
• high blood pressure.

Other side effects include:

• seizures,
• hypertensive crisis,
• abnormal bleeding,
• low blood sodium (hyponatremia), and
• withdrawal syndrome.

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.

Lyrica

• Lyrica may be taken with or without food.
• Treating diabetic peripheral neuropathy: The initial dose for neuropathic pain associated with diabetic peripheral neuropathy is 50 mg three times a day (150 mg/day). The dose may be increased to a maximum dose of 100 mg 3 times daily (300 mg/day) after one week.
• Treating postherpetic neuralgia: The recommended dose for postherpetic neuralgia is 75-150 mg twice daily or 50-100 mg three times daily. Dosing should begin at 75 mg two times a day or 50 mg three times a day (150 mg/day). The dose may be increased to 100 mg 3 times daily (300 mg/day) after one week. If pain relief is inadequate after 2-4 weeks of treatment at 300 mg/day, the dose may be increased to 300 mg twice daily or 200 mg three times daily. Doses greater than 300 mg cause more side effects.
• Treating neuropathic pain associated with spinal cord injury: The dose for treating neuropathic pain associated with spinal cord injury is 150 to 600 mg daily. Begin dosing at 75 mg two times a day an increase to 150 mg two times daily after one week if response is inadequate. May increase to 300 mg twice daily if response is inadequate after 2 to 3 weeks.
• Treating seizures: The recommended dose for treating seizures is 150-600 mg/day divided into 2 or 3 doses, starting at 150 mg daily and increasing based on response and tolerability. The maximum dose is 600 mg/day.
• Treating fibromyalgia: Fibromyalgia is treated with 300-450 mg/day in 2 or 3 divided doses.

Savella

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).

Lyrica

• Alcohol and drugs that cause sedation may increase the sedative effects of pregabalin.
• Pioglitazone (Actos) and rosiglitazone (Avandia) cause weight gain, fluid retention, and possibly heart failure. Therefore, combining pregabalin with these drugs may increase the occurrence of weight gain and fluid retention.

Savella

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.

Lyrica

• There are no adequate studies of Lyrica in pregnant women.
• It is not known whether Lyrica is excreted in breast milk.

Savella

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.