- What is Savella (milnacipran)? How does it work (mechanism of action)?
- What is the drug Savella used for?
- What are the side effects of Savella?
- What is the dosage for Savella?
- Which drugs or supplements interact with Savella?
- Is Savella safe to take if you are pregnant or breastfeeding?
- What else should you know about Savella?
What is Savella (milnacipran)? 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.
- The brand name for milnacipran is Savella.
- Milnacipran available in generic form. You need a prescription to obtain milnacipran.
What are the side effects of Savella?
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.
What is the dosage for Savella?
The recommended starting dose for Savella 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 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.
Is Savella safe to take if you are pregnant or breastfeeding?
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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Related Disease Conditions
Fibromyalgia 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.
Pain 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. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
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