Milnacipran

Milnacipran is a prescription-only drug used to treat fibromyalgia, a condition that causes muscle stiffness and widespread pain. Milnacipran is a selective serotonin-norepinephrine reuptake inhibitor (SSNRI) that increases the levels of these neurotransmitters in the brain. Milnacipran is well tolerated but should only be used as prescribed to avoid drug interactions and if complicating medical conditions are absent.

Milnacipran brand names

Milnacipran is sold under the brand name Savella.

What is milnacipran prescribed for?

Milnacipran is a drug therapy used in the treatment of fibromyalgia, a chronic condition that causes various problems in the muscles, ligaments, tendons, and related tissues, such as muscle stiffness, tenderness, and pain. Patients with fibromyalgia also typically experience tiredness due to difficulty falling asleep, staying asleep, or both.^[1]

Other common symptoms of fibromyalgia include the following:^[2]

• Depression
• Anxiety
• Paresthesia (tingling or prickly sensations)
• A general decline in physical functioning

How does milnacipran work?

In basic terms, Savella helps alleviate pain associated with fibromyalgia by increasing serotonin and norepinephrine in the brain. Both of these neurotransmitters aid in preventing pain signals from being transmitted. More specifically, Savella prevents the reuptake of serotonin and norepinephrine, which allows both chemicals to remain in more significant amounts in the synaptic area.

Savella is a rapid-absorbing drug that takes roughly two to four hours to achieve peak concentration. Furthermore, Savella exhibits low protein binding, meaning it can more freely diffuse and be distributed throughout the body.

This drug is primarily excreted via urine. About 50 to 60 percent of the original drug dosage is eliminated in this fashion. The drug’s half-life is roughly six to eight hours.^[2]

How is milnacipran usually taken?

Milnacipran is taken orally in tablet form. The initial dose is administered once on the first day of treatment. Subsequent doses are taken twice daily.

The initial dosage is usually low and gradually builds up during the first week. Common dosages include 12.5mg, 25mg, 50mg, and 100mg. Milnacipran is also available in varying strengths.^[1][3]

This drug can be taken at any time, though it’s advisable to take it at the same time each day. Milnacipran can be taken with or without food. However, doctors usually recommend patients take it with food to minimize the risk of an upset stomach.

How long does milnacipran stay in your system?

Milnacipran stays in your system between 33-44 hours. This estimate is based on its half-life of six to eight hours and the general rule that it takes 5.5 half-lives for a drug to be eliminated from the body.^[4]

Milnacipran side effects

As with any drug, milnacipran comes with the risk of adverse effects. Some side effects are more common and less severe, while others are rare but much more dangerous.

Common milnacipran side effects

After taking milnacipran, you may experience some side effects. These could include: 

• Stomach pain
• Nausea
• Vomiting
• Constipation
• Difficulty urinating

Sexual problems

• Headache
• Dry mouth
• Extreme facial warmth
• Blurred vision
• Rash and/or itching
• Loss of appetite and/or weight loss
• Lack of energy
• Extreme tiredness

Though the side effects most people experience are mild and go away within a few days/weeks of starting the medication, in some cases, they might become severe and/or long-lasting. If this is the case, call your doctor.^[1]

Severe milnacipran side effects

More concerning side effects can occur with milnacipran, too. Seizures, fainting, and coma are possible for some people. Others experience a fast or irregular heartbeat, trouble breathing, or fever.

Other severe side effects of milnacipran include the following:

• Hallucinations
• Confusion
• Trouble concentrating
• Difficulty with memory
• Dizziness and unsteady walking
• Severe muscle stiffness or weakness
• Uncontrollable body shakes

Call your doctor immediately if you experience any of the symptoms above or diarrhea, pain in the upper part of your stomach, muscle weakness, or yellowing of the skin or eyes. Likewise, if you experience abnormal bleeding or bruising, nosebleeds, or dark-colored urine, seek medical help.^[1]

Milnacipran precautions

Due to the risk of irregular heartbeat when taking Savella, you should check your blood pressure and heart rate before treatment initiation. You should continue to have your blood pressure and heart rate checked throughout your milnacipran treatment.^[1]

Likewise, Savella might cause angle-closure glaucoma in which pressure in the eye increases rapidly and, in severe cases, can cause vision loss. SSNRIs like Savella are also associated with an increased risk of suicidal ideation. If you are concerned about suicidal thoughts on this medication, talk with a healthcare professional.^[2]

Of course, any other medical or mental health concerns (e.g., pregnancy, drug addiction, an organ disease, bipolar disorder) should be discussed openly and honestly with your doctor or healthcare provider to ensure it’s safe to take Savella.^[3]

Milnacipran interactions

Milnacipran should not be taken if you are taking an MAOI or stopped taking one within the last 14 days. A dangerous interaction between milnacipran and MAOIs can cause a hypertensive crisis (a rapid increase in blood pressure) or serotonin syndrome (a potentially life-threatening condition that involves autonomic, neuromuscular, and mental health problems due to too much serotonin in the brain).^[2][5]

You should also avoid taking milnacipran if you take other drugs that cause drowsiness, as the two together can worsen your sleepiness. This includes sleeping medications, opioids, muscle relaxers, anticonvulsants, and anxiolytics.^[3]

Care should be taken to provide your physician with a complete list of other prescriptions, over-the-counter drugs, herbal supplements, and vitamins that you take to reduce the likelihood of an interaction with milnacipran. This list should include not only the substances you’re currently taking but also those you have recently stopped taking, including alcohol and controlled substances.

Milnacipran storage

Milnacipran should be stored at room temperature, away from moisture and heat. Avoid storing it in the bathroom, as it tends to be warmer with more moisture in the air than other rooms in the home. Keep this medication out of sight and reach of children and pets in its original container.

What to do if you overdose on milnacipran

An overdose might have occurred if you or someone you know experiences any of the following:

• Extreme sleepiness
• Loss of consciousness
• Slowed or stopped heartbeat
• Seizure
• Difficulty breathing
• Confusion
• Dizziness

You can get more information about signs of a drug overdose from America’s Poison Centers. Call the poison helpline at 1-800-222-1222, your physician, or 911 if any of these symptoms are present.