Milnacipran, Oral mil-NAY-si-pran

What are other names for this medicine?

Type of medicine: selective serotonin and norepinephrine reuptake inhibitor (SSNRI)

Generic and brand names: milnacipran, oral; Savella

What is this medicine used for?

This medicine is taken by mouth to treat fibromyalgia in adults.

What should my healthcare provider know before I take this medicine?

Tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine or to food dyes
• an enlarged prostate or trouble urinating
• bipolar disorder, depression, thoughts of suicide, or other mood disorders
• bleeding problems
• blood pressure, heart rhythm, or other heart problems
• glaucoma
• kidney or liver disease
• problems with alcohol or drug abuse
• problems with low levels of sodium in the blood
• seizures

Tell your provider if you have taken MAO inhibitors such as phenelzine (Nardil), tranylcypromine (Parnate), selegiline (Eldepryl), or isocarboxazid (Marplan) within the past 2 weeks.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while taking this medicine without your healthcare provider's approval.

How do I take it?

Read the Medication Guide that comes in the medicine package when you start taking this medicine and each time you get a refill.

Check the label on the medicine for directions about your specific dose. Take this medicine exactly as your healthcare provider prescribes. Do not take more or take it longer than prescribed. You may take this medicine with or without food. Taking it with meals may lessen the chance the drug will upset your stomach.

You may need to take this medicine for a long time. If you need to take this medicine for more than a few days, do not stop taking it suddenly. You may have to reduce your dosage gradually to avoid withdrawal symptoms. Follow your healthcare provider's instructions.

What if I miss a dose?

If you miss a dose, take it as soon as you remember unless it is almost time for the next scheduled dose. In that case, skip the missed dose and take the next one as directed. Do not take double doses. If you are not sure of what to do if you miss a dose, or if you miss more than one dose, contact your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this medicine, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this medicine, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: nausea, vomiting, diarrhea, restlessness, confusion, fast heartbeat, chest pain, dizziness, lightheadedness, fainting, coma.

What should I watch out for?

This medicine affects the brain the same way as some antidepressants. Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. Talk with your provider about this. Behavior changes may be caused by the medicine or by depression or another mental illness. Contact your provider right away if you or your family notice any disturbing changes in your thoughts or behavior.

This medicine may cause serotonin syndrome, which can be life-threatening. It may be caused by taking this medicine in combination with other medicines. These medicines include antidepressants, medicines to treat migraines, pain medicines, some cough medicines, St. John’s wort, and others. Make sure that your providers know ALL of the medicines that you take.

You need to have blood tests and blood pressure checks regularly to see how this medicine affects you. Keep all appointments for these tests.

This medicine may cause blurred vision and dizziness. Do not drive or operate machinery until you are fully alert and can see clearly. You may feel dizzy or faint when you get up quickly after sitting or lying down. Getting up slowly may help. Also, drinking alcohol may make it worse. This medicine may increase the effects of alcohol and other drugs that slow down your nervous system. Do not drink alcohol unless your healthcare provider approves.

Adults over the age of 65 may be at greater risk for side effects. Talk with your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away). If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; chest pain or tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report these to your healthcare provider right away): Seizures; chest pain; irregular or fast heartbeat; severe dizziness; lightheadedness; unusual nervousness, restlessness, or irritability; panic attacks; hallucinations; confusion; high fever; loss of coordination or trouble walking; trouble concentrating; memory loss; worsening depression or thoughts of suicide; unusual mood or behavior changes; yellowing of the skin or eyes; dark urine; light-colored stools; unusual tiredness or weakness; severe nausea, vomiting, or diarrhea; unusual bleeding or bruising, trouble urinating.

Other: Nausea, vomiting, constipation, dry mouth, loss of appetite, headache, dizziness, trouble sleeping, change in sexual ability or desire, increased sweating, flushing, blurred vision, rash, itching, weight loss.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• antidepressants such as amitriptyline, citalopram (Celexa), clomipramine (Anafranil), doxepin, duloxetine (Cymbalta), fluoxetine (Prozac), fluvoxamine (Luvox CR), nortriptyline (Pamelor), paroxetine (Paxil), and sertraline (Zoloft)
• antipsychotic medicines such as chlorpromazine, fluphenazine, perphenazine, thioridazine, and thiothixene (Navane)
• antiseizure medicines such as carbamazepine (Tegretol) and phenobarbital (Luminal)
• buspirone (BuSpar)
• clonidine (Catapres)
• digoxin (Lanoxin)
• diuretics (water pills) such as amiloride, chlorothiazide (Diuril), furosemide (Lasix), hydrochlorothiazide, and spironolactone (Aldactone)
• cough and cold medicines such as chlorpheniramine (Chlor-Trimeton), dextromethorphan, and diphenhydramine (Benadryl)
• linezolid (Zyvox)
• lithium (Lithobid, Eskalith)
• MAO inhibitor antidepressants such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• medicines to treat migraines such as almotriptan (Axert), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan succinate (Imitrex), and zolmitriptan (Zomig)
• medicine that reduces the chance of blood clots forming such as aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, and warfarin (Coumadin)
• muscle relaxants such as baclofen (Lioresal), carisoprodol (Soma), cyclobenzaprine (Flexeril), dantrolene (Dantrium), methocarbamol (Robaxin), and tizanidine (Zanaflex)
• natural remedies such as gotu kola, kava, SAMe, St. John's wort, tryptophan, and valerian
• narcotic pain medicines such as codeine, fentanyl (Duragesic), hydrocodone (Vicodin), hydromorphone (Dilaudid), meperidine (Demerol), methadone (Dolophine), morphine, oxycodone (Percocet, OxyContin), and tramadol (Ultram)
• NSAIDs such as diclofenac (Voltaren), ibuprofen (Motrin, Advil), indomethacin (Indocin), ketorolac (Toradol), naproxen (Anaprox, Aleve), and oxaprozin (Daypro)
• procarbazine (Matulane)
• sedatives and tranquilizers such as alprazolam (Xanax), temazepam (Restoril), triazolam (Halcion), zaleplon (Sonata), and zolpidem (Ambien)
• stimulants and diet pills such as atomoxetine (Strattera) dextroamphetamine (Dexedrine, Dextrostat), epinephrine, methamphetamine (Desoxyn), and methylphenidate (Ritalin)

Do not drink alcohol while you are taking this medicine.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

How should I store this medicine?

Store this medicine at room temperature. Keep the container tightly closed. Protect it from heat, high humidity, and bright light.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Keep all medicines out of the reach of children.

Do not share medicines with other people.