Milnacipran

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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

  1. abdominal pain
  2. anorexia
  3. anxiety
  4. bleeding
  5. blurred vision
  6. cardiomyopathy
  7. chest pain (unspecified)
  8. chills
  9. confusion
  10. constipation
  11. cystitis
  12. delirium
  13. depression
  14. diarrhea
  15. dizziness
  16. drowsiness
  17. dysgeusia
  18. dyspepsia
  19. dyspnea
  20. dysuria
  21. ecchymosis
  22. ejaculation dysfunction
  23. elevated hepatic enzymes
  24. epistaxis
  25. erythema multiforme
  26. fatigue
  27. fever
  28. flatulence
  29. flushing
  30. galactorrhea
  31. gastroesophageal reflux
  32. hallucinations
  33. headache
  34. hematoma
  35. hepatitis
  36. hostility
  37. hot flashes
  38. hypercholesterolemia
  39. hyperhidrosis
  40. hyperprolactinemia
  41. hypertension
  42. hypertensive crisis
  43. hypoesthesia
  44. hyponatremia
  45. impotence (erectile dysfunction)
  46. infection
  47. insomnia
  48. irritability
  49. jaundice
  50. leukopenia
  51. libido decrease
  52. mania
  53. migraine
  54. nausea
  55. neonatal abstinence syndrome
  56. neutropenia
  57. night sweats
  58. oliguria
  59. palpitations
  60. pancreatitis
  61. paresthesias
  62. peripheral edema
  63. petechiae
  64. physiological dependence
  65. platelet dysfunction
  66. prostatitis
  67. pruritus
  68. pseudoparkinsonism
  69. rash
  70. renal failure (unspecified)
  71. rhabdomyolysis
  72. seizures
  73. serotonin syndrome
  74. sinus tachycardia
  75. Stevens-Johnson syndrome
  76. suicidal ideation
  77. supraventricular tachycardia (SVT)
  78. testicular pain
  79. testicular swelling
  80. thrombocytopenia
  81. tremor
  82. urethral pain
  83. urinary retention
  84. vomiting
  85. weight gain
  86. weight loss
  87. withdrawal
  88. 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

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