What is milnacipran?
Milnacipran affects certain chemicals in the brain called neurotransmitters. An abnormality in these chemicals is thought to be related to fibromyalgia. Milnacipran is not used to treat depression but how it works in the body is similar to how some antidepressants work.
Milnacipran is used to treat a chronic pain disorder called fibromyalgia.
Milnacipran may also be used for other purposes not listed in this medication guide.
Do not use milnacipran together with thioridazine (Mellaril), or an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam). Serious and sometimes fatal reactions can occur when these medicines are taken with milnacipran. You must wait at least 14 days after stopping an MAO inhibitor before you can take milnacipran. After you stop taking milnacipran, you must wait at least 5 days before you start taking an MAOI.
You should not use this medication if you are allergic to milnacipran, or if you have untreated or uncontrolled narrow-angle glaucoma.
If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before you take milnacipran, tell your doctor if you have:
- liver or kidney disease;
- heart disease, high blood pressure, heart rhythm disorder;
- seizures or epilepsy;
- a bleeding or blood clotting disorder such as hemophilia;
- enlarged prostate, urination problems;
- bipolar disorder (manic depression);
- a history of heavy alcohol use;
- a history of suicidal thoughts or actions; or
- if you are allergic to aspirin or yellow food dye.
You may have thoughts about suicide while taking this medication, especially if you are younger than 24 years old. Tell your doctor if you have new or worsening depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.
Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.
FDA pregnancy category C. It is not known whether milnacipran is harmful to an unborn baby. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment.
It is not known whether milnacipran passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
Older adults may be more sensitive to the side effects of this medication.
Do not give milnacipran to anyone younger than 17 years old without the advice of a doctor.
Avoid drinking alcohol while taking milnacipran. Alcohol may increase the risk of damage to your liver.
Milnacipran can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
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Seek emergency medical attention if you think you have taken too much of this medication. Overdose symptoms may include confusion, dizziness, slow heart rate, weak pulse, fainting, and slow breathing (breathing may stop).
Take the missed dose as soon as you remember. However, if it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up the missed dose.
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Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.
Call your doctor at once if you have any of these serious side effects:
- fast or pounding heartbeats;
- painful or difficult urination;
- easy bruising or bleeding, nosebleeds, bloody or tarry stools, coughing up blood;
- confusion, hallucinations, severe weakness, seizure (convulsions);
- high fever, sweating, chills or goose bumps, memory problems, trouble concentrating, loss of coordination, overactive reflexes, vomiting, diarrhea;
- high blood pressure (severe headache, blurred vision, buzzing in your ears, chest pain, shortness of breath, uneven heartbeats); or
- stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Less serious side effects may include:
- dry mouth, nausea, stomach pain, heartburn, bloating;
- dizziness, drowsiness, headache, tired feeling;
- stuffy nose, sneezing, or other cold symptoms;
- sleep problems (insomnia);
- swelling in your hands or feet;
- hot flashes, sweating, itching, mild skin rash;
- numbness or tingling;
- blurred vision; or
- decreased sex drive, impotence, or difficulty having an orgasm.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may report side effects to FDA at 1-800-FDA-1088.
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Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety can add to sleepiness caused by milnacipran. Tell your doctor if you regularly use any of these medicines.
Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren), indomethacin, piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others. Taking any of these drugs with milnacipran may cause you to bruise or bleed easily.
Tell your doctor about all other medications you use, especially:
- a blood thinner such as warfarin (Coumadin);
- clonidine (Catapres, Clorpres);
- a diuretic (water pill);
- digoxin (digitalis, Lanoxin);
- epinephrine (Epi-Pen);
- lithium (Lithobid, Eskalith);
- tramadol (Ultram);
- tryptophan (sometimes called L-tryptophan);
- migraine headache medicine such as almotriptan (Axert), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, Treximet), or zolmitriptan (Zomig); or
- an antidepressant such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), paroxetine (Paxil), or sertraline (Zoloft).
This list is not complete and there may be other drugs that can interact with milnacipran. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.
milnacipran and Savella
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Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2004 Cerner Multum, Inc. Version 2.05. Revision date 8/23/04