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Milnacipran

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Milnacipran, Savella

  • See Also
  1. Serotonin-Norepinephrine Reuptake Inibitors (SNRI)
  2. Levomilnacipran (Fetzima)
  3. Duloxetine
  4. Venlafaxine
  5. Desvenlafaxine
  6. Fibromyalgia
  • Indications
  1. Fibromyalgia (FDA approved)
  2. Major Depression (off label; other SNRI is preferred)
  • Safety
  1. Unknown safety in Lactation
  2. Pregnancy Category C
  • Preparations
  1. Milnacipran (Savella) 12.5 mg, 25 mg, 50 mg, 100 mg tablets
  1. Start: 12.5 mg orally daily for 2-3 days, then
  2. Next: 12.5 mg orally twice daily for 2-3 days, then
  3. Next: 25 mg orally twice daily
  4. Next: May increase to 50 mg orally twice daily
  5. Maximum: 200 mg/day
  6. Decrease dose by 50% in severe renal Impairment (eGFR <30 ml/min)
  • Adverse Effects
  1. Nausea or Vomiting
  2. Constipation
  3. Hyperhidrosis
  4. Dry Mouth
  5. Tachycardia and Palpitations
  6. Increased Blood Pressure
  7. Serotonin Syndrome
  8. Suicidality
  • Drug Interactions
  1. Avoid with Monoamine Oxidase Inhibitors (MAO Inhibitors), including Linezolid and methylene blue
  • Resources
  1. Milnacipran (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=9b3d078b-d12f-47ef-baa4-35b88b090ed4
  • References
  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia