Milnacipran is used to treat fibromyalgia. It is a serotonin-norepinephrine reuptake inhibitor (SNRI) that increases levels of serotonin and norepinephrine in the brain. Common side effects include nausea and vomiting, constipation, dizziness, and dry mouth. Serious side effects are less common but can include low sodium levels in the blood, abnormal bleeding, or increased blood pressure or heart rate. Before taking milnacipran, tell your healthcare provider about any health conditions or medicines you are taking.
Uses
What is milnacipran used for?
Milnacipran is commonly used to treat fibromyalgia.
Milnacipran may also be used for other conditions as determined by your healthcare provider.
How does milnacipran work (mechanism of action)?
Milnacipran belongs to a group of medicines called serotonin-norepinephrine reuptake inhibitors (SNRIs). It works by increasing the amount of natural chemicals called norepinephrine and serotonin in the brain.
How is milnacipran supplied (dosage forms)?
Brands and other names
- Savella
Dosage forms and strengths
- 12.5 mg, 25 mg, 50 mg, 100 mg oral tablets
How should I store milnacipran?
Milnacipran should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.
Side Effects
What are the most common side effects of milnacipran?
The most common side effects of milnacipran are listed below. Tell your healthcare provider if you have any of these side effects that bother you.
- Nausea and vomiting
- Headache
- Constipation
- Dizziness
- Trouble sleeping
- Hot flushes or increased sweating
- Increased blood pressure (see below)
- Increased heart rate (see below)
- Feeling of skipped heartbeats
- Dry mouth
There may be other side effects of milnacipran that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
What are the serious side effects of milnacipran?
While less common, the most serious side effects of milnacipran are described below, along with what to do if they happen.
Severe Allergic Reactions. Milnacipran may cause allergic reactions, which can be serious. Stop taking milnacipran and get help right away if you have any of the following symptoms of a serious allergic reaction.
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, or throat
- Trouble swallowing or throat tightness
- Itching, skin rash, or pale red bumps on the skin called hives
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
Suicidal Thoughts or Actions. Milnacipran may increase the risk of suicidal thoughts or actions in a small number of children, teenagers, or young adults. The risk is higher in the first few months of taking the medicine or when the dose is changed. Depression or other serious mental health conditions are the most important causes of suicidal thoughts or actions. If you or your child is about to harm themselves, call 911 or call or text 988, the Suicide & Crisis Lifeline. Call your healthcare provider right away if you have any of the following symptoms.
- New or increased thoughts of suicide or death
- Suicide attempt
- New or increased feelings of anxiety, depression, or other unusual changes in your mood or behavior
Serotonin Syndrome. Serotonin syndrome is when there is too much of a substance called serotonin in your body. Milnacipran can cause serotonin syndrome when it is taken alone or with other medicines that affect serotonin. This condition can be life-threatening. Get emergency help if you have any of the following symptoms of serotonin syndrome.
- Sweating, fever, or flushing
- Confusion
- Feeling agitated or restless
- Seeing or hearing unusual things
- Dizziness
- Fast or racing heartbeat
- Nausea, vomiting, or diarrhea
- Muscle twitching, stiffness, or tremor
- Seizures
Increased Heart Rate. Milnacipran may cause your heart rate to increase. Your healthcare provider will check your heart rate before you start treatment with this medicine. During treatment, your provider will monitor your heart rate and blood pressure on a regular basis.
Increased Blood Pressure (Hypertension). Milnacipran may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your healthcare provider if your blood pressure increases while taking this medicine.
If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your healthcare provider right away if you have any of the following symptoms of severely high blood pressure.
- Sudden severe headache
- Chest pain
- Dizziness or confusion
- Trouble breathing
- Nausea or vomiting
- Blurry or other changes to vision
- Anxiety
- Buzzing in the ears
- Nosebleed
- Feeling of skipped heartbeats
Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking milnacipran. Call your healthcare provider right away if you have any of the following symptoms of liver damage.
- Nausea or vomiting
- Stomach or belly pain
- Fever
- Weakness or unusual tiredness
- Itching
- Loss of appetite
- Light-colored poop
- Dark-colored urine (pee)
- Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
Seizures. Some people who have taken milnacipran have reported having seizures. There are many different types of seizures and some of them are not easy to recognize. Stop taking milnacipran and call your healthcare provider if you have any of the following signs that a seizure is happening or could happen.
- Muscle twitching, jerking, spasms, tremors, or other uncontrolled movements
- Stiffening of your arms and legs
- Feeling anxious, nervous, confused, or a sense of dread
- Feeling dizzy or lightheaded
- Falling or losing consciousness
Low Sodium Levels (Hyponatremia). Milnacipran may cause low sodium levels. Call your healthcare provider if you have any of the following symptoms of a low sodium level.
- Headache
- Drowsiness
- Muscle weakness or cramps
- Nausea, vomiting, or loss of appetite
- Tiredness or sleepiness
- Dizziness
- Weight gain
- Restlessness or irritability
- Change in your mental condition such as hallucinations, confusion, decreased awareness, or alertness
- Seizures
Abnormal Bleeding. People taking milnacipran or other antidepressants may have an increased risk of bleeding or bruising. You may be at higher risk if you are also taking aspirin, a nonsteroidal anti-inflammatory drug (NSAID), like ibuprofen or naproxen, or a blood thinner such as warfarin, apixaban (Eliquis), or rivaroxaban (Xarelto). Tell your healthcare provider if you notice any changes in how easily you bruise or bleed.
Extremely Elevated Mood (Mania). People with bipolar disorder can have severe high and low moods. The first symptom of bipolar disorder may be depression. People with bipolar disorder who take milnacipran may have a higher risk of having mania or a manic episode. Call your healthcare provider right away if you have any of the following symptoms of a manic episode.
- Very increased energy
- Significant trouble sleeping
- Racing, fast-paced thoughts
- Reckless behavior
- Unusually grand ideas
- Excessive happiness or irritability
- Talking more or faster than usual
Inability to Empty Bladder (Urinary Retention). Milnacipran might make it harder to empty your bladder, especially if you already have a blockage or take other medicines for overactive bladder. Stop taking milnacipran and call your healthcare provider right away if you are having trouble peeing or cannot empty your bladder.
Glaucoma. Milnacipran may increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness. Tell your healthcare provider right away if you have any of the following symptoms of glaucoma.
- Loss of vision
- Eye pain or redness
- Severe headache or vomiting
- Seeing bright, colorful circles around lights (vision halos)
Sexual Problems. Taking milnacipran or another serotonin-norepinephrine reuptake inhibitor (SNRI) may cause sexual problems. Tell your healthcare provider if you have any of the following sexual problems.
- Decreased sex drive
- Delayed ejaculation or unable to have an ejaculation
- Problems getting or keeping an erection
- Delayed orgasm or unable to have an orgasm
Warnings & Precautions
Who should not use milnacipran?
Allergies to Ingredients. People who are allergic to any of the following should not take milnacipran.
- Milnacipran
- Savella
- Any of the ingredients in the specific product dispensed
Your pharmacist can tell you all of the ingredients in the specific milnacipran products they stock.
Drug Interactions. Milnacipran should not be taken while you are using certain other medicines. Before taking milnacipran, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.
What should I know about milnacipran before using it?
Do not take milnacipran unless it has been prescribed to you by a healthcare provider. Take it as prescribed.
Do not share milnacipran with other people, even if they have the same condition as you. It may harm them.
Keep milnacipran out of the reach of children.
Milnacipran can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how milnacipran affects you.
People who are 65 and older can be at greater risk for some side effects from milnacipran. Talk to your healthcare provider about your risks if you are in this age group.
You don’t have to take milnacipran with food, but taking it with food may help you tolerate it better.
Do not stop taking milnacipran without talking to your healthcare provider. Stopping too quickly may cause serious side effects. Call your healthcare provider right away if you have any of the following symptoms.
- Anxiety, irritability, or high or low mood
- Feeling restless
- Changes in sleep habits
- Headache
- Sweating or shaking
- Nausea
- Dizziness
- Electric-shock like feelings
- Confusion
- Ringing in the ears
- Seizures
What should I tell my healthcare provider before using milnacipran?
Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if milnacipran is right for you.
In particular, make sure that you discuss any of the following.
Current and Past Heath Conditions. Tell your healthcare provider if you have or have had any of the following.
- Mental health conditions, including current or past depression, suicidal thoughts or actions, bipolar disorder, mania, or hypomania (including personal history or family history)
- High blood pressure
- Heart problems, including fast heartbeat or stroke
- Liver or kidney problems
- Bleeding problems
- Problems with peeing or emptying the bladder
- Prostate problems
- Glaucoma
- Seizures
- Low sodium levels in the blood
Also, tell your healthcare provider if you drink alcohol.
Pregnancy. Taking milnacipran later in pregnancy may lead to an increased risk of certain problems in you and your unborn baby. Tell your healthcare provider if you are or plan to become pregnant. Your healthcare provider will advise you if you should take milnacipran while you are pregnant or trying to become pregnant. If you become pregnant while taking milnacipran, you can register for the Savella Pregnancy Registry by calling 877-643-3010, by emailing [email protected], or by going to www.savellapregnancyregistry.com
Breastfeeding. Milnacipran passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take milnacipran while breastfeeding. If you breastfeed your baby, tell your healthcare provider right away if your baby is irritable or not eating well.
Interactions
Does milnacipran interact with foods or drinks?
There are no known interactions between milnacipran and foods or drinks.
It is unknown if drinking alcohol will affect milnacipran, but heavy drinking may increase the risk of having liver problems with milnacipran. It is best to limit the amount of alcohol you drink.
Does milnacipran interact with other medicines (drug interactions)?
Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are taking.
In particular, make sure that you discuss if you are using any of the following before taking milnacipran.
- A monoamine oxidase inhibitor (MAOI) within the past two weeks, which is a medicine usually used for depression or Parkinson’s disease
- Linezolid, which is a medicine used to treat bacterial infections
- A selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI), which is a medicine commonly used for anxiety and depression
- A tricyclic antidepressant, such as amitriptyline, nortriptyline, or protriptyline, even if it is not used for depression
- A triptan, such as sumatriptan (Imitrex and others), eletriptan (Relpax), and others, which is a medicine commonly used to treat migraines
- An opioid, such as fentanyl, meperidine, methadone, or tramadol, which is a medicine used for certain types of pain
- Lithium, which is a medicine for certain mental health conditions
- Tryptophan, which is a supplement that may be used to help the body make proteins and certain brain-signaling chemicals
- Buspirone, which is a medicine for anxiety
- Amphetamines, such as Adderall, which are used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy
- St. John’s wort, which is a supplement that may be used to treat depression
- Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
- Clonidine (Catapres-TTS and others), which is a medicine used for high blood pressure or attention deficit hyperactivity disorder (ADHD)
- An antiplatelet medicine, such as clopidogrel (Plavix), ticagrelor (Brilinta), aspirin/dipyridamole, or cilostazol, which is a medicine used to prevent blood clots
- A blood thinner, such as warfarin, which is a medicine used to treat or prevent blood clots
- A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, and others, which is in many prescription and OTC products for pain, swelling, and fever
This may not be a complete list of medicines that can interact with milnacipran. Always check with your healthcare provider.
Overdose/Missed Dose
What should I do if I accidentally use too much milnacipran?
If you or someone else has used too much milnacipran, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.
What should I do if I miss a dose of milnacipran?
If you miss a dose, skip the missed dose and only take the next dose when you normally would. Do not take double or extra doses.
Are you currently using Milnacipran (Savella)?
This survey is being conducted by the WebMD marketing sciences department.