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Precautions and Warnings With Milnacipran

There are many precautions and warnings with milnacipran to be aware of before starting treatment, including information on who should not take this medicine. You should not take milnacipran if you have uncontrolled narrow-angle glaucoma or have taken an MAOI within the past two weeks. Potential problems that could occur when taking this medication include liver problems, low blood pressure, and seizures.

What Should I Tell My Healthcare Provider Before Taking Milnacipran?

You should talk with your healthcare provider prior to taking milnacipran hydrochloride (Savella®) if you have:
Also, let your healthcare provider know if you:
  • Are pregnant or thinking of becoming pregnant
  • Are breastfeeding
  • Drink alcohol regularly.
Make sure to tell your healthcare provider about any other medications you are taking, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Specific Warnings and Precautions With Milnacipran

Warnings and precautions to be aware of prior to taking milnacipran include the following:
  • Antidepressants may increase the risk of suicidal thinking or behavior in children, teenagers, and adults (see Depression and Suicide). Even though milnacipran is not approved for depression treatment in the United States, it is in the same drug category as some antidepressants. Therefore, if you notice any changes in depression symptoms or new symptoms, talk to your healthcare provider immediately. Some of these symptoms may include:
    • Anxiety
    • Hostility
    • Agitation
    • Panic
    • Restlessness
    • Hallucinations
    • Extreme hyperactivity
    • Suicidal thinking or behavior.
  • Taking milnacipran with other medications that affect serotonin can increase your risk of a dangerous group of symptoms called serotonin syndrome. These other medications include other antidepressants, triptans (migraine medications), and other medications (see Drug Interactions With Milnacipran). Contact your healthcare provider immediately if you have any possible symptoms of serotonin syndrome, including:
    • Confusion or other mental changes
    • A rapid heart rate
    • Nausea
    • Vomiting
    • Diarrhea
    • Hallucinations
    • Blood pressure changes
    • Overactive reflexes
    • Fever
    • Shivering
    • Shakiness
    • Agitation
    • Sweating
    • Seizures
    • Coma.
  • Milnacipran has been reported to cause liver problems, including hepatitis. This medication is not recommended for people who have liver problems or who drink large amounts of alcohol regularly, due to an increased risk of liver damage.
  • Milnacipran can cause low blood pressure (hypotension). This may be more common if you are also taking other medications, especially high blood pressure medications. Tell your healthcare provider if you have symptoms of low blood pressure, including lightheadedness, dizziness, or fainting.
  • This medication can increase blood pressure and heart rate. Your healthcare provider should monitor these things while you are taking milnacipran. If you already have high blood pressure, this condition should be adequately treated before starting milnacipran.
  • This medication may increase the risk of seizures. Talk to your healthcare professional before taking milnacipran if you have a history of seizures.
  • If you are stopping milnacipran, you should be monitored by a healthcare provider for withdrawal symptoms. If you do develop any symptoms of withdrawal (such as irritability, anxiety, confusion, headache, lethargy, or insomnia), your healthcare provider may slow down the rate at which the medication is stopped.
  • If you are elderly or taking a diuretic, milnacipran could cause low salt levels in the blood (hyponatremia). This generally returns to normal when the medication is discontinued, but can be serious in severe cases. Signs of hyponatremia include:
    • Headaches
    • Difficulty with concentration, memory problems, or confusion
    • Unsteadiness or falling
    • Hallucinations
    • Fainting
    • Seizures
    • Coma.
  • Milnacipran can increase the risk of bleeding, including dangerous internal bleeding. Check with your healthcare provider before taking this drug if you have a bleeding disorder or if you take any anticoagulant, "blood thinning" medications (see Drug Interactions With Milnacipran).
  • Milnacipran can increase the risk of mania (often noticed as an extreme increase in activity and talking), especially in people with a history of mood disorders such as bipolar disorder. Make sure your healthcare provider knows your full mental health history before you take this drug.
  • This medication can make narrow-angle glaucoma worse. If your glaucoma is under control, your healthcare provider should monitor the condition to make sure it is not getting worse. If your glaucoma is not under control, you should not take milnacipran.
  • Milnacipran can cause painful urination or other bladder or urination problems, especially in men with problems such as an enlarged prostate (benign prostatic hypertrophy). Make sure to tell your healthcare provider about any urinary problems you have before taking this drug or any bladder problems that develop during treatment.
  • People who drink alcohol frequently should not take milnacipran, as heavy alcohol use may increase the risk of liver damage.
  • Milnacipran is considered a pregnancy Category C medication. This means that it may not be safe to use during pregnancy. Talk to your healthcare provider about the risks and benefits associated with this (see Savella and Pregnancy for more information).
  • It is not known if milnacipran passes through breast milk. Therefore, if you are breastfeeding or plan to start, be sure to talk with your healthcare provider before using this drug (see Savella and Breastfeeding).  

    More Headlines in Precautions and Warnings With Milnacipran

    ‣ Who Should Not Take Milnacipran?
    ‣ Milnacipran Warnings and Precautions: Final Thoughts
    Last reviewed by: Kristi Monson, PharmD
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