- Fibromyalgia Overview Slideshow
- Take the Fibromyalgia Quiz
- Fibromyalgia: 12 Tips for Coping Slideshow
- What is milnacipran, and how does it work (mechanism of action)?
- What brand names are available for milnacipran?
- Is milnacipran available as a generic drug?
- Do I need a prescription for milnacipran?
- What are the side effects of milnacipran?
- What is the dosage for milnacipran?
- Which drugs or supplements interact with milnacipran?
- Is milnacipran safe to take if I'm pregnant or breastfeeding?
- What else should I know about milnacipran?
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 are the side effects of milnacipran?
The most frequent side effects include:
- excessive sweating,
- increased heart rate,
- dry mouth, and
- high blood pressure.
Other side effects include:
- 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.
Quick GuideFibromyalgia 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?
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).
Milnacipran (Savella) is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) drug prescribed for the treatment of pain associated with fibromyalgia. Side effects, drug interactions, warnings and precautions, and patient information should be reviewed prior to taking any medication.
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Top milnacipran Related Articles
Chronic PainChronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Cymbalta duloxetine and Effexor XR venlafaxine
Cymbalta, brand name duloxetine, and Effexor XR brand name venlafaxine (Effexor has been discontinued) are antidepressants belonging to a drug class called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Cymbalta and Effexor are used for the treatment of chronic depression, anxiety disorders (for example, general or social), and pain. Cymbalta also treats fibromyalgia, and musculoskeletal or diabetic neuropathy (nerve pain).
Similar side effects of Cymbalta and Effexor include headaches, insomnia, anxiety, nausea, and dry mouth. Both Cymbalta and Effexor can cause serious side effects like increased blood pressure, erectile dysfunction (ED, impotence) and seizures. They also may increase the risk of suicidality.
Side effects that occur with Cymbalta that do not occur with Effexor include constipation, diarrhea, and fatigue. Effexor may cause side effects like sleepiness, loss of appetite, weight loss, and sweating. If Cymbalta or Effexor are stopped abruptly they may cause withdrawal symptoms like irritability, insomnia, anxiety, nervousness, dizziness, nausea, vomiting, and diarrhea.
The brand name Effexor is no longer available in the US; however, Effexor XR is.
desvenlafaxine (Pristiq)Desvenlafaxine (Pristiq, Khedezla) is a drug used to treat depression. Desvenlafaxine (Pristiq) belongs to a class of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Information about side effects, drug interactions, and safety with pregnancy or breastfeeding should be reviewed prior to taking this drug.
Cymbalta (duloxetine) is in the drug class SSRI. Cymbalta is prescribed for the treatment of:
- generalized anxiety disorder,
- and neuropathic pain associated with diabetic peripheral neuropathy.
The most common side effects of Cymbalta are:
- dry mouth,
- and dizziness.
Fibromyalgia FactsFibromyalgia is a chronic pain condition characterized by symptoms such as fatigue, sleep disturbances, and tender points. Stress reduction, exercise, and medication are the standard treatments for fibromyalgia.
Fibromyalgia PictureA syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. See a picture of Fibromyalgia and learn more about the health topic.
Head and Neck CancerHead and neck cancer is cancer of the oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, larynx, or lymph nodes in the upper part of the neck. These cancers account for 3% to 5% of cancers in the U.S. Tobacco and alcohol use are important risk factors. Treatment may involve surgery, radiation therapy, and/or chemotherapy.
Pain ManagementPain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain include:
- complex regional pain syndrome,
- interstitial cystitis,
- and irritable bowel syndrome.
Take the Pain QuizIs pain all in the brain? Take the Pain Quiz to learn everything you've ever wanted to know about the unpleasant sensation we call pain.
venlafaxineVenlafaxine (venlafaxine, Effexor XR; Effexor has been discontinued in the US) is a drug in the class of drugs called SNRIs (serotonin and norepinephrine reuptake inhibitors) prescribed for the treatment of depression, depression with symptoms of anxiety, generalized anxiety disorder. Effexor XR is prescribed for the treatment of and panic disorder in adults. Side effects, drug interactions, dosage, and pregnancy safety information should be reviewed prior to taking this medication.