Indications 

Savella functions by altering the activity of neurotransmitters in the brain, which are believed to play a role in the development of fibromyalgia, a condition characterized by persistent muscle and joint pain. 

While Savella’s mechanism of action is comparable to certain antidepressants, this medication is not indicated for the treatment of depression. 

Savella is intended for the management of chronic pain associated with fibromyalgia, a medical disorder characterized by chronic muscle and joint pain. 

Uses and Dosage 

Prior to using milnacipran, carefully read the Medication Guide provided by your pharmacist, both before commencing treatment and with each refill. In case of any inquiries, consult with your physician or pharmacist. 

Milnacipran should be taken orally, with or without food, usually twice daily, as instructed by your doctor. If you experience nausea, taking this medication with food may be helpful. 

The dosage of milnacipran is dependent on your medical condition and response to treatment. To reduce the likelihood of adverse effects, your doctor may begin with a low dose and gradually increase it.  

Follow your doctor’s instructions diligently, do not increase your dosage, and avoid taking the medication more frequently than prescribed. Doing so will not expedite the healing process, and it may heighten the risk of severe side effects. 

If you suddenly stop taking this medication, withdrawal symptoms such as mood swings, headaches, tiredness, changes in sleep patterns, and brief electric shock-like sensations may occur.  

To prevent withdrawal symptoms, your doctor may gradually decrease your dose. Withdrawal symptoms are more likely to occur if you have been taking milnacipran for a prolonged period or in high doses. Immediately notify your doctor or pharmacist if you experience withdrawal symptoms. 

Side Effects 

Allergic Reactions

If you experience an allergic reaction to Savella, seek emergency medical help immediately. Symptoms may include: 

• Hives 
• Difficulty breathing 
• Swelling of your face, lips, tongue, or throat 

Severe Side Effects

Report any new or worsening symptoms to your doctor. These may include: 

• Mood or behavior changes 
• Depression 
• Anxiety 
• Panic attacks 
• Trouble sleeping 
• Feeling impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), or having thoughts about suicide or hurting yourself 

Call your doctor immediately if you experience any of the following: 

• Little or no urination 
• Blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights 
• A seizure 
• A light-headed feeling, like you might pass out 
• Liver problems – stomach pain (upper right side), itching, dark urine, or jaundice (yellowing of the skin or eyes) 
• Low sodium level – headache, confusion, severe weakness, vomiting, problems with thinking or memory, or feeling unsteady 
• Manic episodes – racing thoughts, increased energy, unusual risk-taking behavior, extreme happiness, or being irritable or talkative 

If you experience symptoms of serotonin syndrome, seek medical attention immediately. These may include: 

• Agitation 
• Hallucinations 
• Fever 
• Sweating 
• Shivering 
• Fast heart rate 
• Muscle stiffness 
• Twitching 
• Loss of coordination 
• Nausea 
• Vomiting 
• Diarrhea 

Common Side Effects

Some side effects may be more likely in older adults. Common Savella side effects may include: 

• Nausea, vomiting, or constipation 
• Dry mouth 
• Increased blood pressure 
• Fast or pounding heartbeats 
• Increased sweating or flushing (warmth, redness, or tingly feeling) 
• Headache or dizziness 
• Trouble sleeping 

Caution 

Milnacipran is contraindicated for patients who have used an MAO inhibitor in the previous 14 days due to the risk of a dangerous drug interaction. Examples of MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine. If a patient has stopped taking milnacipran, they must wait at least 5 days before starting an MAOI. 

Milnacipran is not recommended for children under 18 years of age. 

Patients should inform their doctor of any medical conditions they have, including liver disease, kidney disease, heart disease, high blood pressure, seizures or epilepsy, bipolar disorder, bleeding problems, low sodium levels, sexual problems, alcohol consumption, and the use of blood thinners such as warfarin.  

Patients should inform their doctor of any other medications they are taking, including stimulant medicine, opioid medicine, herbal products, or medication for depression, mental illness, Parkinson’s disease, migraine headaches, serious infections, or nausea and vomiting prevention. These medications may interact with milnacipran and cause serotonin syndrome. 

Patients taking milnacipran should be monitored closely for changes in mood or symptoms by their doctor or other caregivers. Milnacipran should not be discontinued abruptly without the advice of a doctor. 

Milnacipran may cause serious complications in a developing fetus if taken during pregnancy. Patients should inform their doctor immediately if they become pregnant while taking milnacipran.  

The safety of breastfeeding while taking this medication is unknown, and patients should consult their doctor before breastfeeding. Patients may be included in a pregnancy registry to monitor the effects of milnacipran on their baby.