Milnacipran HCl

Milnacipran HCl (Savella) is a selective serotonin and norepinephrine reuptake inhibitor. It affects the two neurotransmittersalmost equally. However, the exact mechanism of the central pain inhibitory action of milnacipran and its ability to improve the symptoms of fibromyalgia in humans are unknown.

Indications

Management of fibromyalgia.

Dosage

Administered orally with or without meal. Adult : On day 1 a single 12.5mg dose, day2-3 = 12.5mg twice a day, day 4-7 = 25mg twice a day, after 7 days = 50mg twice daily, Maximum daily dose is 100mg twice daily. For patient with sever renal impairment, reduce maintenance dosage by 50% to 25mg twice daily which may be increased to 50mg twice daily

Contra-Indications

Uncontrolled narrow angle glaucoma, concomitant use with MAOIs or within 14 days of discontinuing treatment with an MAOI; ESRD, Chronic liver disease, alcohol use.

Special Precautions

Children below 17 years of age, pregnancy, lactation, elderly, moderate to severe renal or hepatic impairment, abrupt discontinuance may cause withdrawal symptoms, do not drive or operate machinery, monitor for emergence of serotonin syndrome or NMS - like signs and symptoms, history of dysurea, seizures, mania and hypomania, controlled narrow angle glaucoma.

Side Effects

Hyponatremia, nausea, headache, constipation, dizziness, insomnia, elevated heart rate, pain in the chest increased blood pressure, seizures, anxiety, agitation, panic attacks, restlessness, shortness of breath, extreme depression or suicidal thoughts or behaviour.

Drug Interactions

Bleedding disorders can occur with drugs that interfere with serotonin reuptake.