Milnacipran ($ Savella)
SNRI antidepressant
- Major Depression3 (approved outside US)
- Fibromyalgia (FDA approved)
- Chronic Pain
Features
Dosing
Start 12.5 mg qd, then 12.5 mg bid (day 2-3), then 25 mg bid (day 4-7), then 50 mg bid. Can go up to 100mg bid for depression.
INTERACTIONS: Lower dose 50% with CYP3A4 inhibitors (nefazodone, grapefruit juice, ketoconazole, clarithromycin, ritonavir). Raise dose x1.3 if using with carbamazepine.
Management
Contains 50% levomilnacipran (Fetzima) in racemic mix. Approved for depression in Europe but only for fibromylagia in USA.
TOLERABILITY: Nausea, sexual dysfunction, sleep disruption, restless legs.
RISKS: Osteopenia in post-menopausal women. Hyponatremia. Serotonin syndrome.
EMR Text
Depression
Milnacipran use based on controlled trials in major depressive disorder.
Milnacipran side effects reviewed with patient.
Fibromyalgia
Milnacipran use based on FDA approval in fibromyalgia.
Milnacipran side effects reviewed with patient.