Milnacipran (Oral)

Milnacipran is a drug that is used in the treatment of patients with the condition, fibromyalgia.

Overview

In the US, milnacipran is known by its brand name, Savella. It is a prescription only drug that comes in tablet dosage form.

Milnacipran is used to relieve the muscle stiffness and pain that is suffered by patients with a condition called fibromyalgia. The medication is one of a family of drugs called selective serotonin and norepinephrine reuptake inhibitors, or SNRIs.

The drug works by causing the activity of the chemicals norepinephrine and serotonin to be increased within the patient's brain, effectively relieving some of the symptoms caused by fibromyalgia.

Patients should be aware that milnacipran will not provide a cure for your fibromyalgia, but it can help to reduce the debilitating muscle pain and stiffness that the condition causes.

Conditions treated

  • Fibromyalgia

Type of medicine

  • SNRI
  • Tablet

Side effects

In addition to the effects it is designed to have, some medications can cause unwanted side effects. Not everyone using milnacipran will suffer any ill effects, but if they do manifest themselves, they may need further medical treatment.

If any of the following effects occur, you should check with your health care professional:

  • Yellow eyes and skin
  • Weight gain
  • Vomiting
  • Pain in the upper right abdominal or stomach areas
  • Unusually pale skin
  • Unexpected weight gain or loss
  • Unusual tiredness or weakness
  • Unusual nervousness, excitement, or restlessness
  • Unusual bleeding or bruising
  • Twitching
  • Trouble sleeping
  • Problems concentrating
  • Shaking and trembling of the fingers and hands
  • Tiredness
  • Tingling of the feet or hands
  • Tightness of the chest
  • Tic-like movements of the face, head, mouth, and neck
  • Acting or talking with uncontrollable excitement
  • Tender, swollen prostate
  • Swollen glands
  • Swelling of the ankles, face, lower legs, or fingers
  • Swelling of the stomach or abdominal area
  • Sweating
  • Stiffness of the legs and arms
  • White spots, sores, or ulcers, in the mouth or on the lips
  • Sore throat
  • Sneezing
  • Slurred speech
  • Slow movements
  • Slow or rapid heartbeat
  • Shuffling walk
  • Shakiness in the arms, legs, feet, or hands
  • Severe muscle stiffness
  • Seizures
  • Hallucinations
  • Runny nose
  • Restlessness
  • Irritated, red eyes
  • Red, purple-centred skin lesions
  • Rapid weight gain
  • Feeling of pressure in the stomach
  • Pounding in the ears
  • Poor coordination
  • Red pinpoint spotting on the skin
  • Burning or pain with urination
  • Overactive reflexes
  • Nasal congestion
  • Muscular pain or stiffness
  • Muscle cramps or spasms
  • Muscle aches
  • A mask-like facial expression
  • Lower back or side pain
  • Loss of voice
  • Loss of pleasure or interest
  • Loss of consciousness
  • Loss of balance control
  • Light-colored stools
  • Poor appetite
  • Itching
  • Feelings of irritability
  • Increased thirst
  • Increased sweating
  • High fever
  • Heartburn
  • Headaches
  • Groin pain
  • Feelings of general tiredness and weakness
  • Full or bloated feeling
  • Frequent urination
  • Frequent urge to urinate
  • Fever
  • Feeling sad or empty
  • Fear or nervousness
  • Rapid, pounding, irregular, or racing pulse or heartbeat
  • Ear congestion
  • Dizziness
  • Feelings of discouragement
  • Difficulty in swallowing
  • Difficulty in breathing
  • Difficulty in passing urine (dribbling)
  • Painful or difficult urination
  • Diarrhea
  • Dark-colored urine
  • Cough
  • Convulsions
  • Confusion as to time, place, or person
  • Coma
  • Chills
  • Chest pain or discomfort
  • Crawling, burning, itching, prickling, numbness, tingling, or "pins and needles" sensations
  • Bruising
  • Body aches or pains
  • Blurred vision
  • Bloody or cloudy urine
  • Blood in the urine or stools
  • Swelling or bloating of the arms, face, hands, feet, or lower legs
  • Peeling, blistering, or loosening of the skin
  • Bleeding gums
  • Bladder pain
  • Black, tarry stools
  • Back pain
  • Agitation

There are some side effects that patients using milnacipran may experience that do not usually require further medical treatment. These effects usually disappear on their own when your body gets used to the new medication. In addition, your treating physician may be able to suggest ways in which you can reduce or prevent some of these unwanted effects. Ask your treating physician for advice if any of the effects listed below prove to be persistent or troublesome, or if you have any concerns about them:

  • Excessive or unexpected milk flow from the breasts
  • Swelling of the testes
  • Swelling of the breasts or unexpected milk production
  • Sudden sweating
  • Stomach pain, discomfort, or upset
  • Sleepiness or unusual drowsiness
  • Reddening of the face, arms, neck, and sometimes of the upper chest
  • Rash
  • Excessive passing of gas
  • Inability to ejaculate semen
  • Night sweats
  • Loss of taste
  • Loss in sexual ability, drive, desire, or performance
  • Irritability
  • Indigestion
  • Inability to obtain or keep an erection
  • Heartburn
  • Severe and throbbing headache
  • Full feeling
  • Excess air or gas in the intestines or stomach
  • Decreased libido
  • Decreased appetite
  • Change in taste
  • Bloated
  • Belching
  • Acid or sour stomach
  • Abdominal or stomach pains

There may be other side effects that are experienced by patients taking milnacipran that are not listed in this guide. If you notice any odd effects, check with your treating physician right away.

Dosage

You must only use milnacipran as you have been directed by your treating physician. Do not use more or less than prescribed, do not increase the frequency of dosage, and do not use the drug for longer than you have been told to.

When you collect your prescription, you will be given a medication guide. Be sure to read the guide thoroughly and follow the instructions it contains. If you have any questions, check with your health care professional.

This medication can be taken with or without food.

The dose of milnacipran that you are prescribed may be different to that for other patients. You should keep to the dosage directions on the package or your doctor's directions. The directions contained in this guide are based only on the average for this drug. Do not change your dose if it is different, unless you are told to do so by your health care professional.

The dose of milnacipran you are prescribed will depend on how strong the medicine is. The number of daily doses you take, the time between them, and the total duration of your course of treatment will depend on the condition for which you are using the drug.

Tablets for the treatment of patients with fibromyalgia

  • Adults:

 First day:

12.5 mg one time

 Second to seventh day:

total 50 mg twice daily in two doses

 Thereafter:

100 mg daily across two doses

Your treating physician may increase the dose up to 200 mg daily across two doses

  • Children: The use and dose rate of this medicine will be determined by your child's GP.

In the event that you omit a dose of your medication, leave out the dose you missed and revert to your original schedule. Do not take a double dose.

Never share your prescription of milnacipran with anyone else.

You must not stop taking your prescription of milnacipran suddenly unless you are told to do so by your doctor. To do so could increase the likelihood of unpleasant side effects.

Interactions

Drug interactions

There are some drugs that should never be used together, as doing so could cause an interaction to take place. In other cases, it is necessary to use two drugs, even though an interaction may occur. In such circumstances, your treating physician may change the dose or frequency of use of one or both of the medicines. When you are using milnacipran, you must tell your doctor if you are using any of the following drugs. This list contains those drugs that cause the most significant interactions. Tell your health care professional if you are using any other drugs that are not on this list.

It is not recommended that you use milnacipran with any of the following drugs, but this may be necessary in some circumstances. If you are prescribed both drugs together, your health care professional may withdraw one of the drugs or change the dose:

  • Zolmitriptan
  • Ziprasidone
  • Zimeldine
  • Xemilofiban
  • Warfarin
  • Vortioxetine
  • Vilazodone
  • Venlafaxine
  • Valdecoxib
  • Tryptophan
  • Trifluoperazine
  • Trazodone
  • Tranylcypromine
  • Tramadol
  • Tolmetin
  • Tolfenamic Acid
  • Tirofiban
  • Ticlopidine
  • Tiaprofenic Acid
  • Thiothixene
  • Thioridazine
  • Tenoxicam
  • Tapentadol
  • Sumatriptan
  • Sulodexide
  • Sulindac
  • Sulfinpyrazone
  • Sodium Salicylate
  • Sibutramine
  • Sibrafiban
  • Sertraline
  • Selegiline
  • Salsalate
  • Salicylic Acid
  • Safinamide
  • Rofecoxib
  • Rizatriptan
  • Rivaroxaban
  • Risperidone
  • Rasagiline
  • Quetiapine
  • Proquazone
  • Propyphenazone
  • Promazine
  • Proglumetacin
  • Procarbazine
  • Pranoprofen
  • Piroxicam
  • Pimozide
  • Piketoprofen
  • Phenylbutazone
  • Phenprocoumon
  • Phenindione
  • Phenelzine
  • Perphenazine
  • Pentosan Polysulfate Sodium
  • Paroxetine
  • Parecoxib
  • Palonosetron
  • Oxyphenbutazone
  • Oxycodone
  • Oxaprozin
  • Olanzapine
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Niflumic Acid
  • Nepafenac
  • Nefazodone
  • Naratriptan
  • Naproxen
  • Nadroparin
  • Nabumetone
  • Morniflumate
  • Molindone
  • Moclobemide
  • Mirtazapine
  • Metoclopramide
  • Methylene Blue
  • Mesoridazine
  • Meperidine
  • Meloxicam
  • Mefenamic Acid
  • Meclofenamate
  • Lumiracoxib
  • Loxoprofen
  • Loxapine
  • Lornoxicam
  • Lorcaserin
  • Lithium
  • Linezolid
  • Lexipafant
  • Levomilnacipran
  • Lamifiban
  • Ketorolac
  • Ketoprofen
  • Isocarboxazid
  • Iproniazid
  • Iobenguane I 123
  • Indomethacin
  • Iloprost
  • Ibuprofen
  • Heparin
  • Haloperidol
  • Granisetron
  • Furazolidone
  • Frovatriptan
  • Fondaparinux
  • Fluvoxamine
  • Flurbiprofen
  • Fluphenazine
  • Fluoxetine
  • Flufenamic Acid
  • Fluconazole
  • Floctafenine
  • Feprazone
  • Fepradinol
  • Fentanyl
  • Fenoprofen
  • Femoxetine
  • Felbinac
  • Etoricoxib
  • Etofenamate
  • Etodolac
  • Escitalopram
  • Eptifibatide
  • Epoprostenol
  • Eletriptan
  • Edoxaban
  • Duloxetine
  • Droxicam
  • Donepezil
  • Dolasetron
  • Dipyrone
  • Dipyridamole
  • Diflunisal
  • Dicumarol
  • Diclofenac
  • Dextromethorphan
  • Dexketoprofen
  • Dexibuprofen
  • Desvenlafaxine
  • Desirudin
  • Dermatan Sulfate
  • Defibrotide
  • Danaparoid
  • Cyclobenzaprine
  • Clozapine
  • Clovoxamine
  • Clopidogrel
  • Clonixin
  • Citalopram
  • Cilostazol
  • Choline Salicylate
  • Chlorpromazine
  • Celecoxib
  • Bupropion
  • Buprenorphine
  • Bufexamac
  • Bromfenac
  • Bivalirudin
  • Benperidol
  • Bemiparin
  • Avitriptan
  • Aspirin
  • Aripiprazole
  • Apixaban
  • Antithrombin III Human
  • Anisindione
  • Ancrod
  • Anagrelide
  • Amtolmetin Guacil
  • Amoxapine
  • Amitriptyline
  • Amisulpride
  • Almotriptan
  • Acenocoumarol
  • Acemetacin
  • Aceclofenac
  • Abciximab

Other interactions

There are some drugs that must not be used around the time of meals or when eating certain food groups as this could cause an interaction. Some drugs may interact with alcohol or tobacco.

It is not recommended that you use milnacipran with ethanol, although this may be unavoidable in some instances. If you do need to use the two together, your health care professional may give you special guidelines on the use of alcohol, tobacco, and food.

Medical interactions

Some other medical conditions can affect how milnacipran works. You must tell your health care professional if you suffer from any other health conditions, especially the following:

Milnacipran should be used with caution if you have any of the following conditions, as this drug can make these problems worse:

  • History of seizures
  • Painful or difficult urination
  • Mania
  • Liver disease
  • Hyponatremia (low sodium in the blood)
  • Hypertension (high blood pressure)
  • Heart rhythm problems
  • Heart disease
  • Glaucoma, angle-closure
  • Enlarged prostate
  • History of depression
  • Bleeding problems
  • Urinary tract blockage

Milnacipran should be used with caution in patients who have a history of kidney problems. The effects of the drug could be increased due to its slower removal from the body.

Warnings

Before you decide to use any medicine, you should take into account the risks as well as the benefits of using it. This decision is best made following discussions with your health care professional. In the case of milnacipran, you should consider the following points:

You must mention to your health care professional any allergic or odd reaction that you have noticed to milnacipran or any other medication, including over the counter products. Be sure to tell your treating physician if you have any other known allergies to food colors, preservatives, animal by-products or particular food groups.

There have been no specific studies performed into the effect of milnacipran on children. If you have any concerns about your child receiving this medicine, discuss them with your child's treating physician.

There have been no specific studies performed into the effect of milnacipran on elderly patients. However, geriatric patients are more prone to age-related kidney disease, necessitating an alteration to the dose of the drug. If you have any concerns about this aspect of your treatment, you should discuss them with your health care professional.

There is no evidence to suggest that using milnacipran while pregnant could cause harm to a fetus. However, you should tell your treating physician if you think you are pregnant and discuss any concerns that you may have in this regard before you begin using this drug.

There are no studies to suggest that milnacipran could be ingested by a nursing infant. However, if you are breastfeeding, you should discuss any possible risks with your midwife or treating physician and perhaps consider using an alternative feeding solution for your infant while you are taking milnacipran.

You must visit your health care professional for regular check-ups while you are using milnacipran. These visits will allow your treating physician to adjust the dose if necessary and will give you the opportunity to mention any side effects that you may be experiencing.

Milnacipran can cause feelings of agitation or irritability in some patients. Some people also experience suicidal thoughts or tendencies and may become more depressed. If you think that you are developing these tendencies, tell your health care professional immediately.

You must not take milnacipran during the 14 days following cessation of a monoamine oxidase inhibitor, for example isocarboxazid, linezolid, methylene blue injection, selegiline, phenelzine, or tranylcypromine. Similarly, you should not take any of these medicines for at least five days after you have stopped using milnacipran. If you have any concerns or questions about this, check with your health care professional.

You must tell your health care professional if you are using aspirin, non-steroidal anti-inflammatory drugs such as ibuprofen, or any form of blood thinning medicine such as warfarin. Milnacipran can cause an increased risk of bleeding problems when used in conjunction with any of these drugs.

You must tell your health care professional about any other forms of medicine that you are taking before you start using milnacipran. Patients should be aware that this drug can cause a serious condition called serotonin syndrome when it is used together with certain anti-depressants and migraine medications, including:

  • St John's wort
  • Fentanyl
  • Lithium
  • Tryptophan
  • Buspirone
  • Rizatriptan
  • Sumatriptan
  • Tramadol
  • Zolmitriptan

Always check with your doctor before you start using any other form of medicine.

Before you begin using milnacipran you must have your pulse and blood pressure measured and recorded. This will also be necessary while you are using the medicine. If you notice any alteration in your pulse rate or blood pressure, check with your health care professional straight away. If you have any concerns or queries about this, talk to your health care professional.

Milnacipran can cause liver problems in some patients. If you notice any of the following signs, you should check with your treating physician right away:

  • Stomach or abdominal pain or tenderness
  • Dark urine
  • Clay-colored stools
  • Poor appetite
  • Headaches
  • Fever
  • Itching
  • Nausea and vomiting
  • Skin rashes
  • Swelling of the lower limbs or feet
  • Feeling unusually tired or weak
  • Jaundice

You should not consume alcohol while you are taking milnacipran.

Some people who are using milnacipran may notice that they feel less alert than usual. If you are affected in this way, do not drive, use machinery, or take part in any other activity that requires you to be fully alert.

You must not suddenly stop taking milnacipran unless you have been told to do so by your health care professional. If you are required to stop using this medicine, your doctor may tell you to reduce the dose gradually before you stop taking it altogether. This will reduce your likelihood of suffering severe side effects.

Storage

You should keep your prescription of milnacipran tablets in a sealed container and at room temperature. Keep the tablets away from heat sources, direct sunlight, and moisture. Do not freeze the medicine.

This drug can present a danger to children and pets. Be sure to keep your milnacipran well out of reach. If a pet consumes any of your tablets, seek veterinary advice right away.

Do not retain any unused or out-of-date milnacipran. Do not throw your tablets in the trash where they could be found by children or animals. Do not flush unwanted medicines down the toilet or drain.

For advice on the safe disposal of your unwanted medicines, consult your doctor or pharmacist.

Summary

Milnacipran is a selective serotonin and norepinephrine reuptake inhibitor that is used to relieve the muscle stiffness and pain caused by fibromyalgia. The medication works by increasing activity levels of norepinephrine and serotonin within the patient's brain.

This is a prescription only drug. It can cause serious side effects and interactions when used with a long list of other drugs, especially anti-depressants and certain pain killers. There are also many historical and existing health conditions that can be exacerbated by milnacipran. Before you start taking this medicine, you must discuss your medical history fully with your health care professional.

In addition, it is important that you attend your health care professional regularly throughout your course of treatment with milnacipran for check-ups to make sure that the drug is working properly and to discuss any side effects that it may be causing.

Milnacipran will not cure your fibromyalgia, but it can help to reduce the muscle pain and stiffness that the condition causes.