II. Indications
- Fibromyalgia (FDA approved)
- Major Depression (off label; other SNRI is preferred)
III. Safety
- Unknown safety in Lactation
- Pregnancy Category C
IV. Preparations
- Milnacipran (Savella) 12.5 mg, 25 mg, 50 mg, 100 mg tablets
V. Dosing: Fibromyalgia
- Start: 12.5 mg orally daily for 2-3 days, then
- Next: 12.5 mg orally twice daily for 2-3 days, then
- Next: 25 mg orally twice daily
- Next: May increase to 50 mg orally twice daily
- Maximum: 200 mg/day
- Decrease dose by 50% in severe renal Impairment (eGFR <30 ml/min)
VI. Adverse Effects
VII. Drug Interactions
- Avoid with Monoamine Oxidase Inhibitors (MAO Inhibitors), including Linezolid and Methylene Blue
VIII. Resources
IX. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
- Hamilton (2020) Tarascon Pocket Pharmacopoeia