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Milnacipran is available as a 12.5 mg, 25 mg, 50 mg, 100 mg oral tablet.

• Milnacipran is a serotonin and norepinephrine reuptake inhibitor (SNRI) that is used to treat fibromyalgia

Milnacipran is a serotonin and norepinephrine reuptake inhibitor (SNRI). While it’s not clear how Milnacipran treats fibromyalgia, it raises the amount of serotonin and norepinephrine in the brain, which might play a role in pain relief.

You’ll usually start with a low dose of Milnacipran and the dose will be raised every few days until you reach a maintenance dose of 50 mg by mouth twice daily.

• Day 1: 12.5 mg by mouth once daily
• Days 2-3: 12.5 mg by mouth twice daily
• Days 4-7: 25 mg by mouth twice daily
• After Day 7: 50 mg by mouth twice daily

Based on how you respond to the medication, your provider might raise your dose to 100 mg twice daily.

Milnacipran is a safe and effective treatment when used for FDA licensed indications. However, like all medications, they may give you unwanted side effects. You should always discuss potential side effects with your physician to ensure the medication is suitable and right for you. Serotonin Syndrome and MAOIs: Do not use MAOIs intended to treat psychiatric disorders with Milnacipran or within 5 days of stopping treatment with Milnacipran. Do not use Milnacipran within 14 days of stopping an MAOI intended to treat psychiatric disorders. In addition, do not start Milnacipran in a patient who is being treated with linezolid or intravenous methylene blue.

Common side effects of Milnacipran:

• Nausea
• Constipation
• Headache
• Trouble falling and staying asleep
• Sudden feeling of warmth (hot flush)
• Dizziness

Serious side effects are rare with Milnacipran. Contact your healthcare provider immediately if you experience any of the following.

• Suicidal thoughts or behaviors
• Serotonin syndrome: high fever, sudden changes in thought, mood, and movement, high blood pressure
• Liver damage: yellowing in your skin or eyes, high fever, pain in your upper stomach area, dark urine
• Low sodium levels: headache, difficulty concentrating, confusion, weakness, unsteadiness, hallucinations, seizures
• Abnormal bleeding: blood in your urine or stool, new bruises or bruises that don’t go away, nosebleeds
• Seizures

The following medications may interact with Milnacipran:

• Milnacipran is unlikely to be involved in clinically significant pharmacokinetic drug interactions
• Pharmacodynamic interactions of Milnacipran with other drugs can occur

Various FDA-approved generic manufacturers

Milnacipran use in third trimester may increase risk for symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulty, hypotonia, tremor, irritability) in the neonate. Milnacipran should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to
Milnacipran during pregnancy. Physicians are advised to recommend that pregnant patients taking Milnacipran enroll in the Milnacipran Pregnancy Registry. Enrollment is voluntary and may be initiated by pregnant patients or their healthcare providers by contacting the registry at 1-877-643-3010 or by email at pregnancyregistries@incresearch.com.

• Savella