Milnacipran Brand Name– Savella
What is Milnacipran
Milnacipran is an oral serotonin norepinephrine reuptake inhibitor (SNRI) antidepressant used for the management of fibromyalgia in the United States.
Milnacipran is approved in some other countries for major depressive disorder. There is no consensus for a single medication as first-line therapy for fibromyalgia because high quality, direct comparator studies are lacking and meaningful conclusions cannot be made.
In addition, no single medication appears to be fully effective for treating the entire spectrum of fibromyalgia symptoms, which commonly include pain, sleep disturbances, depressed mood, and fatigue. A twice daily dosing regimen is one disadvantage of milnacipran.
Conversely, a major advantage of milnacipran is minimal hepatic metabolism and lack of CYP-mediated kinetic interactions.
Similar to other SNRIs, milnacipran has been associated with increases in blood pressure and heart rate and caution is recommended when conditions are present that may be adversely affected by increased blood pressure or heart rate.
Product labels for all antidepressants contain a boxed warning related to an increased risk of suicidality in children, adolescents, and young adults during the initial stages of therapy or during dose changes when treating depression or other conditions; therefore, the necessity of pharmacologic therapy versus the potential risks should be carefully considered in these populations
Indications
- depression
- fibromyalgia
Side Effects
- abdominal pain
- anorexia
- anxiety
- bleeding
- blurred vision
- cardiomyopathy
- chest pain (unspecified)
- chills
- confusion
- constipation
- cystitis
- delirium
- depression
- diarrhea
- dizziness
- drowsiness
- dysgeusia
- dyspepsia
- dyspnea
- dysuria
- ecchymosis
- ejaculation dysfunction
- elevated hepatic enzymes
- epistaxis
- erythema multiforme
- fatigue
- fever
- flatulence
- flushing
- galactorrhea
- gastroesophageal reflux
- hallucinations
- headache
- hematoma
- hepatitis
- hostility
- hot flashes
- hypercholesterolemia
- hyperhidrosis
- hyperprolactinemia
- hypertension
- hypertensive crisis
- hypoesthesia
- hyponatremia
- impotence (erectile dysfunction)
- infection
- insomnia
- irritability
- jaundice
- leukopenia
- libido decrease
- mania
- migraine
- nausea
- neonatal abstinence syndrome
- neutropenia
- night sweats
- oliguria
- palpitations
- pancreatitis
- paresthesias
- peripheral edema
- petechiae
- physiological dependence
- platelet dysfunction
- prostatitis
- pruritus
- pseudoparkinsonism
- rash
- renal failure (unspecified)
- rhabdomyolysis
- seizures
- serotonin syndrome
- sinus tachycardia
- Stevens-Johnson syndrome
- suicidal ideation
- supraventricular tachycardia (SVT)
- testicular pain
- testicular swelling
- thrombocytopenia
- tremor
- urethral pain
- urinary retention
- vomiting
- weight gain
- weight loss
- withdrawal
- xerostomia
Monitoring Parameters
- serum creatinine/BUN
Contraindications
- abrupt discontinuation
- alcoholism
- anticoagulant therapy
- bipolar disorder
- bleeding
- breast-feeding
- cardiac arrhythmias
- cardiac disease
- children
- closed-angle glaucoma
- dehydration
- driving or operating machinery
- eclampsia
- geriatric
- hepatic disease
- hypertension
- hyponatremia
- hypovolemia
- increased intraocular pressure
- jaundice
- mania
- MAOI therapy
- neonates
- obstetric delivery
- pregnancy
- prostatic hypertrophy
- renal disease
- renal failure
- renal impairment
- seizure disorder
- seizures
- suicidal ideation
- thrombolytic therapy
- urinary retention
- urinary tract obstruction
Interactions
- Abciximab
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Codeine
- Acetaminophen; Dextromethorphan
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Hydrocodone
- Acetaminophen; Oxycodone
- Acetaminophen; Pentazocine
- Acetaminophen; Tramadol
- Alfentanil
- Alprazolam
- Alteplase
- Aminosalicylate sodium, Aminosalicylic acid
- Amitriptyline; Chlordiazepoxide
- Amlodipine; Celecoxib
- Amphetamine; Dextroamphetamine Salts
- Anagrelide
- Antithrombin III
- Apixaban
- Argatroban
- Articaine; Epinephrine
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzodiazepines
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Benzphetamine
- Betrixaban
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bivalirudin
- Brompheniramine; Dextromethorphan; Guaifenesin
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Guaifenesin; Hydrocodone
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Buprenorphine
- Buprenorphine; Naloxone
- Buspirone
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Celecoxib
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Chlorpheniramine; Codeine
- Chlorpheniramine; Dextromethorphan
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorthalidone; Clonidine
- Choline Salicylate; Magnesium Salicylate
- Cilostazol
- Citalopram
- Clonazepam
- Clonidine
- Clopidogrel
- Clorazepate
- Cocaine
- Codeine
- Codeine; Guaifenesin
- Codeine; Phenylephrine; Promethazine
- Codeine; Promethazine
- Cyclobenzaprine
- Dabigatran
- Dalteparin
- Danaparoid
- Desirudin
- Desvenlafaxine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextromethorphan
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Dextromethorphan; Promethazine
- Dextromethorphan; Quinidine
- Diazepam
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Dipyridamole
- Diuretics
- Duloxetine
- Edoxaban
- Enoxaparin
- Epinephrine
- Eptifibatide
- Ergot alkaloids
- Escitalopram
- Esomeprazole; Naproxen
- Estazolam
- Ethanol
- Etodolac
- Famotidine; Ibuprofen
- Fenfluramine
- Fenoprofen
- Fentanyl
- Fluoxetine
- Fluoxetine; Olanzapine
- Flurazepam
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Granisetron
- Guaifenesin; Hydrocodone
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Heparin
- Homatropine; Hydrocodone
- Hydrocodone
- Hydrocodone; Ibuprofen
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydromorphone
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indomethacin
- Iobenguane I 131
- Isoniazid, INH
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Ketoprofen
- Ketorolac
- Lansoprazole; Naproxen
- Lasmiditan
- Lepirudin
- Levomilnacipran
- Levorphanol
- Linezolid
- Lisdexamfetamine
- Lithium
- Lorazepam
- Lorcaserin
- Magnesium Salicylate
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Meperidine
- Meperidine; Promethazine
- Methadone
- Methamphetamine
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methylene Blue
- Methylphenidate
- Midazolam
- Mirtazapine
- Monoamine oxidase inhibitors
- Morphine
- Morphine; Naltrexone
- Nabumetone
- Nalbuphine
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nefazodone
- Netupitant, Fosnetupitant; Palonosetron
- Nonsteroidal antiinflammatory drugs
- Norepinephrine
- Oxaprozin
- Oxazepam
- Oxycodone
- Oxymorphone
- Ozanimod
- Palonosetron
- Paroxetine
- Pentazocine
- Pentazocine; Naloxone
- Pentosan
- Phentermine
- Phentermine; Topiramate
- Piroxicam
- Platelet Inhibitors
- Prasugrel
- Prilocaine; Epinephrine
- Procarbazine
- Quazepam
- Rasagiline
- Remifentanil
- Reteplase, r-PA
- Rivaroxaban
- Rofecoxib
- Safinamide
- Salicylates
- Salsalate
- Selective serotonin reuptake inhibitors
- Selegiline
- Serotonin-Receptor Agonists
- Sertraline
- Sibutramine
- Solriamfetol
- St. John’s Wort, Hypericum perforatum
- Streptokinase
- Sufentanil
- Sulindac
- Tapentadol
- Tedizolid
- Temazepam
- Tenecteplase
- Thrombolytic Agents
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tirofiban
- Tolmetin
- Tramadol
- Trazodone
- Triazolam
- Tricyclic antidepressants
- Urokinase
- Valdecoxib
- Venlafaxine
- Vilazodone
- Vorapaxar
- Vortioxetine
- Warfarin
- Zolpidem