Milnacipran | Side Effects, Dosage, Uses & More
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Generic Name:

milnacipran, Oral tablet

All Brands

  • Savella
SECTION 1 of 5

Highlights for milnacipran

Oral tablet
1

Milnacipran is used to manage fibromyalgia symptoms in adults.

2

This drug comes in the form of a tablet you take by mouth.

3

Milnacipran is available as a brand-name drug called Savella. It’s also available as a generic drug.

4

The more common side effects of this drug include nausea, vomiting, headache, constipation, dizziness, and trouble sleeping. They also include hot flashes, increased sweating, palpitations (irregular heartbeat), dry mouth, and hypertension (high blood pressure).

5

In some cases, milnacipran can cause serious side effects. These can include suicidal thoughts or actions (thoughts or behaviors of harming yourself), hallucinations (seeing or hearing something that isn’t there), delirium, high fever, and heart problems. They can also include seizures, liver problems, withdrawal symptoms, abnormal bleeding, and problems with urination (especially in men).

IMPORTANT INFORMATION

FDA warning

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.

Suicidal thoughts warning. Drugs similar to this drug increase the risk of suicidal thinking and behavior (thoughts or behaviors of harming yourself) in children, adolescents, and young adults. This drug may also cause suicidal thinking and behavior in these people.

High blood pressure and heart rate

This drug may cause high blood pressure or a faster heart rate. Your doctor may check your blood pressure and pulse before starting and during your treatment with this drug.

Liver problems

This drug may cause you to have increased liver enzymes. This is a sign of liver damage. You shouldn’t use this drug if you have liver disease or drink large amounts of alcohol.

Seizures

This drug may cause you to have seizures. If you have a history of seizures, talk to your doctor about whether this drug is safe for you.

What is milnacipran?

This drug is a prescription drug. It’s available as an oral tablet.

This drug is available as the brand-name drug called Savella. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version.

Why it's used

This drug is used to treat symptoms of fibromyalgia. Fibromyalgia is a condition that’s marked by pain all over your body, fatigue, trouble sleeping, memory loss, and mood changes. It may be caused by the way your brain process pain signals from your body. Fibromyalgia is more common in women.

How it works

This drug belongs to a class of drugs called selective serotonin and norepinephrine reuptake inhibitors (SNRIs). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

It isn’t known exactly how milnacipran works to treat pain and improve symptoms of fibromyalgia.

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milnacipran Side Effects

Oral tablet

More Common Side Effects

The more common side effects of milnacipran can include:

  • nausea

  • headache

  • constipation

  • dizziness

  • trouble sleeping

  • hot flashes (sudden feeling of warmth, usually around face or chest)

  • increased sweating

  • vomiting

  • palpitations (irregular heartbeat)

  • fast heart rate

  • dry mouth

  • hypertension (high blood pressure)

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

Call your doctor right away if you have serious side effects. Call 9-1-1 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Suicidal thoughts or actions. Symptoms can include:

    • attempts to commit suicide
    • acting on dangerous impulses
    • acting aggressive, angry, or violent
    • thoughts about suicide or dying
    • new or worse depression
    • new or worse anxiety or panic attacks
    • feeling agitated, restless, or irritable
    • insomnia (trouble sleeping)
    • an increase in activity or talking more than normal
    • other unusual changes in behavior or mood
  • Serotonin syndrome. This condition occurs when your levels serotonin (a natural brain chemical) are dangerously high. This drug increases the levels of serotonin in your brain. Your risk may be higher if you take milnacipran with other drugs that increase your levels of serotonin. Symptoms can include:

    • agitation
    • hallucinations (seeing or hearing something that isn’t real)
    • coma (being unconscious for a long time)
    • confusion
    • trouble thinking
    • problems with coordination or muscle twitching (overactive reflexes)
    • sweating or high fever
    • diarrhea
    • stiff muscles
    • dizziness
    • tremors (involuntary movements)
  • Heart problems. Symptoms can include:

    • high blood pressure
    • fast heart rate
  • Seizures or convulsions

  • Liver problems. Symptoms can include:

    • itching
    • right upper stomach pain
    • dark-colored urine
    • yellowing of your skin or the whites of your eyes
    • enlarged liver
    • increased liver enzymes
  • Low sodium (salt) levels in your blood. Symptoms can include:

    • headache
    • weakness or feeling unsteady
    • confusion, trouble concentrating or thinking, or memory problems
  • Abnormal bleeding. Symptoms can include:

    • bruising more easily than normal
    • bleeding gums
    • blood in your urine or stool
    • nosebleeds
  • Manic episodes. Symptoms can include:

    • greatly increased energy
    • severe trouble sleeping
    • racing thoughts
    • reckless behavior
    • unusually grand ideas
    • excessive happiness or irritability
    • talking more or faster than normal
  • Problems with urination. Symptoms can include:

    • decreased urine flow
    • not being able urinate
    • pain in your testicles or problems with ejaculation
  • Visual problems. Symptoms can include:

    • eye pain
    • changes in your vision, such as blurred vision or trouble focusing your eyes
    • swelling or redness in or around your eye
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug may cause symptoms of depression and thoughts of suicide (thoughts of harming yourself). This is more likely when you first start taking the drug or during dose changes. You’re at a greater risk of depression if you have a history of depression or suicidal thoughts.

This drug doesn’t cause drowsiness.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

milnacipran May Interact with Other Medications

Oral tablet

Milnacipran can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Alcohol interaction

The use of drinks that contain alcohol can increase your risk of liver problems from milnacipran. If you drink alcohol, talk to your doctor. You may not be able to take this drug.

Medications that might interact with this drug

Drugs you shouldn’t take

Taking certain drugs with milnacipran may cause serious side effects. You should avoid these medications. These drugs include:

  • Monoamine oxidase inhibitors (MAOIs), such as linezolid, selegiline, methylene blue, or phenelzine. Taking these drugs together can cause serotonin syndrome. You shouldn’t start taking MAOIs within 5 days of stopping milnacipran. You also shouldn’t start taking milnacipran within 14 days of stopping an MAOI.
  • Digoxin. When given intravenously (IV), digoxin may lower your blood pressure and increase your heart rate when taken with milnacipran. You should avoid taking IV digoxin with milnacipran. It isn’t known if oral digoxin interacts with milnacipran. Your doctor should monitor for low blood pressure and elevated heart rate if you take oral digoxin with milnacipran.

Drugs that cause more side effects

Taking milnacipran with certain medications may cause more side effects. These drugs include:

  • Clomipramine. When switching from clomipramine to milnacipran, you have a higher risk of low blood pressure when changing positions and euphoria (intense happiness). 
  • Triptans for migraine headache. Taking these drugs together increases your risk of serotonin syndrome. Your doctor will watch you closely if you take these drugs together. 
  • Tricyclic antidepressants. Taking these drugs together increases your risk of serotonin syndrome. Your doctor will watch you closely if you take these drugs together.   
  • Pain medicines, such as fentanyl and tramadol. Taking these drugs together increases your risk of serotonin syndrome. Your doctor will watch you closely if you take these drugs together. 
  • Antidepressants or mood stabilizers, such as buspirone, lithium, or St. John’s wort. Taking these drugs together increases your risk of serotonin syndrome. Your doctor will watch you closely if you take these drugs together. 
  • Epinephrine or norepinephrine. Taking these drugs with milnacipran may cause high blood pressure that comes and goes and heart rhythm problems.

Interactions that can make drugs less effective

Milnacipran may reduce the levels of certain drugs in your blood. These drugs include:

Clonidine. Milnacipran may block the blood pressure lowering effect of clonidine. 

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Drug warnings
urinary problems
People with urinary problems

If you’re a man with prostate or other urinary tract issues, this drug may make you have more problems with urination. These include not being able to urinate and painful urination.

kidney problems
People with kidney problems

If you have kidney problems or a history of kidney disease, you may not be able to clear this drug from your body. This may increase the levels of etoposide in your body and cause more side effects. Your doctor may adjust your dose if you have kidney disease.

pregnant women
Pregnant women

This drug is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to the fetus.

breast-feeding
Women who are breast-feeding

This drug passes into breast milk and may cause side effects in an infant who is breast-fed.

Talk to your doctor if you breast-feed your child. You may need to decide whether to stop breast-feeding or stop taking this medication.

for seniors
For seniors

The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

If you are over the age of 65 years, you may be at higher risk of having low sodium (salt) levels while taking this drug.

for children
For children

This medication hasn’t been studied in children. It shouldn’t be used in people younger than 18 years of age.

call doctor
When to call the doctor

Call your doctor right away if you get pregnant or plan to become pregnant while taking this drug.

Tell your doctor if your symptoms of fibromyalgia aren’t improving even though you’re taking this drug.

allergies
Allergies

This drug can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your throat or tongue 

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

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How to Take milnacipran (Dosage)

Oral tablet

What are you taking this medication for?

Fibromyalgia

Brand: Savella

Form: Oral tablet
Strengths: 12.5 mg, 25 mg, 50 mg, 100 mg

Generic: milnacipran

Form: Oral tablet
Strengths: 12.5 mg, 25 mg, 50 mg, 100 mg
Adult dosage (ages 18 years and older)
  • Typical starting dose: Your doctor will slowly increase your dose every few days according to this schedule:
    • Day 1: 12.5 mg taken once
    • Days 2 and 3: 12.5 mg taken twice per day
    • Days 4–7: 25 mg taken twice per day
    • After day 7: 50 mg taken twice per day
  • Maximum dose: 100 mg taken two times per day
Child dosage (ages 0–17 years)

It hasn’t been confirmed that milnacipran is safe and effective for use in people younger than 18 years.

Special considerations

Kidney disease: If you have severe kidney disease, your dose should be half of the regular dose. You’ll take 25 mg twice per day. Your doctor may increase your dose to 50 mg taken twice per day if needed.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all

You may have symptoms of withdrawal. Symptoms of withdrawal can be severe. They can include:

  • anxiety, irritability, or confusion
  • tiredness or trouble sleeping
  • headache, dizziness, or seizures
  • electric shock-like sensations and ringing in your ears

If you miss doses or don’t take the drug on schedule

Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much

You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • high blood pressure
  • changes in consciousness, ranging from extreme tiredness to coma (being unconscious for a long time)
  • confusion
  • dizziness
  • liver problems
  • heart attack
  • not being able to breathe

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 9-1-1 or go to the nearest emergency room right away.

What to do if you miss a dose

Skip the missed dose and take the next dose at the regular time. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working

Your symptoms of fibromyalgia should get better. You should have less pain and your mood, memory, and sleep should improve.

This drug is used for long-term treatment.

Important considerations for taking this drug
take with or without food
You can take this drug with or without food. Taking it with food may help to reduce upset stomach.
timing
After your first dose, take this drug at the time(s) recommended by your doctor.
storage
Store this drug carefully
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refillable
A prescription for this medication is refillable
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travel
Travel
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clinical monitoring
Clinical monitoring
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not usually stocked
Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead.
hidden costs
Hidden costs
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insurance
Insurance
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Store this drug carefully

  • Store this drug at room temperature. Keep it between 59°F and 86°F (15°C and 30°C). Try to store it close to 77°F (25°C).
  • Don’t store this medication in moist or damp areas, such as bathrooms.

A prescription for this medication is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Kidney function. Your doctor may do blood tests to check how well your kidneys are working. If your kidneys aren’t working well, your doctor may lower your dose of this drug.
  • Mental health and behavioral problems. You and your doctor should watch for any unusual changes in your behavior and mood. This drug can cause new mental health and behavior problems. It may also make problems you already have worse.
  • Blood pressure and heart rate. Your doctor should check your blood pressure and pulse before starting and during treatment with this drug. They may ask you to monitor your blood pressure and heart rate at home between doctor visits.
  • Bleeding. You and your doctor should check for abnormal bleeding or bruising.

Hidden costs

Your doctor may ask you to purchase a blood pressure monitor. This will help you keep track of your blood pressure and heart rate at home between doctor visits.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

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How Much Does milnacipran Cost?

Oral tablet

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on February 17, 2016

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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