Milnacipran

1 medicine

Milnacipran is an SNRI (serotonin-norepinephrine reuptake inhibitor) used to treat fibromyalgia pain and fatigue. Like other antidepressant-class drugs, it carries an increased risk of suicidal thinking in people under 25, and combining it with an MAOI or another serotonergic drug can trigger serotonin syndrome, a medical emergency.

Savella

Milnacipran

25mg

Savella is a antidepressants medication containing Milnacipran, available as 25mg tablets.

from $0.85 / tablet View

Key facts

  • Milnacipran (brand Savella) is an SNRI that raises serotonin and norepinephrine levels in the brain and spinal cord, changing how pain signals are processed.
  • It's taken twice daily, and the dose is usually increased gradually over 1 to 2 weeks to reduce nausea and dizziness.
  • In people under 25, milnacipran and other SNRIs carry an increased risk of suicidal thoughts, especially in the first weeks of treatment. Anyone starting it should be watched closely for new or worsening mood changes.
  • Seek urgent care for agitation, high fever, muscle rigidity, tremor or a fast heart rate, which can signal serotonin syndrome, or for new thoughts of self-harm.

What milnacipran treats

Milnacipran treats fibromyalgia, a condition of widespread musculoskeletal pain, fatigue and sleep disturbance. It's used to reduce pain and improve daily function rather than as a first-line antidepressant, though its dual action on serotonin and norepinephrine overlaps with drugs used for depression.

How milnacipran works

Milnacipran blocks the reabsorption of serotonin and norepinephrine at nerve endings, leaving more of both chemicals available to carry signals between brain and spinal cord cells. This raises the pain threshold and improves mood and energy in people with fibromyalgia.

Before you take it

  • Never combine milnacipran with an MAOI (monoamine oxidase inhibitor), or take one within 14 days of stopping the other; the combination can cause fatal serotonin syndrome.
  • Tell your prescriber about uncontrolled high blood pressure, glaucoma, urinary retention, or a seizure disorder.
  • Combining milnacipran with other serotonergic drugs, such as triptans, tramadol or other antidepressants, raises the risk of serotonin syndrome.
  • Anyone under 25, or with a history of depression or suicidal thoughts, needs close monitoring, especially when starting treatment or changing the dose.

Side effects

Common effects include nausea, headache, increased sweating and constipation.

Stop and seek urgent medical care for:

  • Agitation, confusion, fever, muscle stiffness, tremor or a racing heart, which can signal serotonin syndrome.
  • New or worsening depression, anxiety, or thoughts of suicide or self-harm.
  • Fainting, chest pain, or a significant rise in blood pressure.

Safety essentials

  • Anyone under 25 starting milnacipran should be monitored closely for new or worsening suicidal thoughts, particularly in the first few weeks and after any dose change.
  • Never combine it with an MAOI, and tell every prescriber about all other serotonergic medicines you take, to avoid serotonin syndrome.
  • Do not stop milnacipran abruptly; your prescriber will taper the dose to reduce withdrawal symptoms such as dizziness and irritability.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.