What Is Savella (milnacipran)?

Savella (milnacipran) is a drug that falls into the class of selective serotonin and norepinephrine reuptake inhibitors (SNRIs). This class of drugs is typically prescribed for the treatment of depression and other psychiatric conditions, though it should be noted that Savella has not been approved by the Federal Drug Administration (FDA) for the treatment of depression.

Given that Savella is an SNRI, it effects changes in the body through its interactions with the chemicals within the brain known as neurotransmitters. In particular, patients with fibromyalgia are believed to have imbalances in the levels of neurotransmitters within the brain, which may account for the mechanism of action in terms of Savella’s beneficial effects on symptoms of fibromyalgia.

Savella has been approved for the treatment of symptoms of fibromyalgia.

Previous studies have found that fibromyalgia patients who were prescribed Savella reported less symptoms of pain, overall improvements in terms of their symptoms of fibromyalgia, and improved physical functioning when compared to fibromyalgia patients who were given a placebo.

How Savella (milnacipran) Is Used

Patients with fibromyalgia are generally prescribed Savella to be taken orally either with or without food, though patients who take the medication with food generally report improved tolerability of the drug.

For adults, the recommended daily dose of Savella is 100mg per day, or 50mg taken twice per day. In most cases, the physician will start fibromyalgia patients on a smaller dose and gradually increase the dosage up to the targeted dose. Some patients may need to take 200mg of Savella per day (i.e., 100mg, orally, twice daily). There are no studies currently available examining doses higher than 200mg per day.

fibromyalgiaIt is also important for patients to come off Savella gradually in order to avoid potential withdrawal symptoms. Patients are encouraged to speak with their healthcare provider first before deciding to stop taking any type of medication.

Common side effects reported when taking Savella (milnacipran) include:

  • Dizziness
  • Feeling tired or drowsy
  • Headache
  • Upset stomach, bloating, or constipation
  • Swelling of the hands or feet
  • Dry mouth
  • Weight changes
  • Difficulty sleeping
  • Hot flashes
  • Sweating
  • Complications with sexual functioning

There are also some serious side effects associated with taking Savella (milnacipran). It is important that you contact your doctor as soon as possible if you begin to exhibit any of the following side effects while taking Savella:

  • Pain or straining during urination
  • Pounding heart or rapid heart beat
  • Sensations of fluttering within the chest
  • Increased sensitivity to bruising or bleeding
  • Bloody or tarry bowel movements
  • Diarrhea
  • Nosebleeds
  • Coughing up blood
  • Nausea or vomiting
  • Seizure or involuntary convulsions
  • Severe muscle weakness
  • Oversensitive reflexes or loss of coordination
  • Difficulty concentrating, trouble with memory, or confusion
  • Chills or goose bumps
  • Excessive agitation
  • Fainting or sensations that you may faint
  • Hallucinations
  • Excessive fever
  • Excessively stiff muscles

spilled pillsPatients should let their physician know if they are taking monoamine oxidase inhibitors (MAOIs), such as rasagiline (Azilect), isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), or tranylcypromine (Parnate), or they are taking thioridazine (Mellaril) before taking Savella. Patients must stop their MAOI at least two weeks (i.e., 14 days) prior to taking Savella.

Further, given that Savella is an SNRI, there is some risk for an increase in suicidal thoughts when taking this medication, particularly in adults who are younger than 24 years of age. Your physician will want to monitor you closely for the first few months after starting Savella, in order to assess for suicidal ideation. It is important that you call your doctor right away or seek emergency help if you experience thoughts of suicide for the first time upon taking Savella or if these thoughts are accompanied by other symptoms, including unusual changes in mood, behavior, feelings, or thoughts; thoughts of wanting to hurt yourself; panic attacks; agitation; anxiety; irritability; hostility; impulsivity; aggression; extreme hyperactivity; difficulty sleeping; or restlessness.

Conditions Related To Savella (milnacipran)

fibromyalgia depressionSavella (milnacipran) is a medication that acts in a similar fashion to antidepressant medications. While this medication falls into the class of medications typically used to treat depression, Savella has not been approved by the FDA to treat depression. Savella has received support for treating symptoms of fibromyalgia, however.

Fibromyalgia is a commonly occurring chronic pain condition. In fact, fibromyalgia has been found to affect between six and 12 million adults within the United States alone. Further, it has been suggested that nearly 70% of adults with fibromyalgia go undiagnosed each year. There are a wide variety of symptoms associated with fibromyalgia. The most commonly reported symptoms include symptoms of widespread pain and tenderness that persist for several months or more despite a number of treatment attempts. Savella has been shown to reduce these symptoms of fibromyalgia pain that typically occur within the muscles, ligaments, tendons, and other supporting tissues of the body.

Conclusion

Savella (milnacipran) is a type of medication that falls into the class of drugs known as selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Savella has received ample support for its use in treating symptoms of pain associated with fibromyalgia. Patients who are considering Savella for their fibromyalgia pain must tell their doctor first if they are taking a monoamine oxidase inhibitor (MAOI) or thioridazine (Mellaril). There are a number of side effects associated with taking Savella. Of note, patients may experience an increase in symptoms of suicidal thoughts when taking this medication, particularly among patients who are 24 years of age or younger. Patients should contact their physician immediately or seek emergency help should they experience thoughts of suicide upon starting Savella.

References

  1. Bernstein CD, Albracht KL, Marcus DA. Milnacipran for fibromyalgia: A useful addition to the treatment armamentarium. Expert Opin Pharmacother 2013;14:905-16
  2. Sumpton JE, Moulin DE. Fibromyalgia. Handb Clin Neurol 2014;119:513-27
  3. Derry S, Gill D, Phillips T, Moore RA. Milnacipran for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2012;3:CD008244
  4. Magni LR, Purgato M, Gastaldon C, Papola D, Furukawa TA, Cipriani A, Barbui C. Fluoxetine versus other types of pharmacotherapy for depression. Cochrance Database Syst Rev 2013;7:CD004185
  5. Ablin J, Fitzcharles MA, Buskila D, Shir Y, Sommer C, Hauser W. Treatment of fibromyalgia syndrome: Recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies. Evid Based Complement Alternat Med 2013; Epub