milnacipran (Savella)
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Indications
- fibromyalgia (FDA-approved use)
- used for treatment of depression in Europe
Contraindications
- do not use with 14 days of MAO inhibitor
- narrow-angle glaucoma
- use with caution in patient with a history of dysuria
- use with caution in patient with a history of seizures
- end-stage renal disease
- avoid concurrent use of other antidepressants
Dosage
Tabs: 12.5, 25, 50, 100 mg film-coated, immediate release tablets
Dosage adjustment in renal failure
- decrease dose by 50% for creatinine clearance of 5-30 mL/min
Pharmacokinetics
- majority is excreted unchanged in the urine (55%)
- minimal CYP450-related metabolism
- low binding to plasma protein (13%)
Monitor
- blood pressure & heart rate
- prior to initiation of therapy
- periodically thereafter
Adverse effects
- nausea, headache, palpitations
- hypertension: mean increase of 3 mm Hg in systolic BP
- tachycardia: mean increase of 7-8 beats/min
- hyponatremia due to SIADH
- hepatitis (rare)
- seizures (rare)
- increased risk of mydriasis
Drug interactions
- drug interaction(s) of triptans with SNRIs
- drug interaction(s) of methylene blue with SNRIs
- drug interaction(s) of linezolid with SNRIs
- drug interaction(s) of benzodiazepines with antidepressants
- drug interaction(s) of antidepressants with benzodiazepines
- drug interaction(s) of NSAIDs with antidepressants
Laboratory
Mechanism of action
- serotonin-norepinephrine reuptake inhibitor (SNRI)
- allegedly more potent inhibitor of norepinephrine reuptake than the other SNRIs
- about 1 in 12 patients taking Savella for 3 months will have a 50% or greater improvement in symptoms compared to placebo[1]
Notes
- contains FD&C Yellow No. 5 (tartrazine)
More general terms
More specific terms
References
- ↑ 1.0 1.1 Prescriber's Letter 16(3): 2009 New Drug: Savella (Milnacipran) Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250310&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Arnold LM et al. Efficacy and safety of milnacipran 100 mg/day in patients with fibromyalgia: Results of a randomized, double-blind, placebo- controlled trial. Arthritis Rheum 2010 Sep; 62:2745. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20496365 <Internet> http://dx.doi.org/10.1002/art.27559