What is milnacipran?
Milnacipran affects certain chemicals in the brain called neurotransmitters. An abnormality in
these chemicals is thought to be related to fibromyalgia. Milnacipran is not used to treat depression but
how it works in the body is similar to how some antidepressants work.
Milnacipran is used to treat a chronic pain disorder called fibromyalgia.
Milnacipran may also be used for other purposes not listed in this medication guide.
What should I discuss with my healthcare provider before taking milnacipran?
Do not use milnacipran together with thioridazine (Mellaril), or an MAO inhibitor such as
isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or
selegiline (Eldepryl, Emsam). Serious and sometimes fatal reactions can occur when these medicines
are taken with milnacipran. You must wait at least 14 days after stopping an MAO inhibitor before you
can take milnacipran. After you stop taking milnacipran, you must wait at least 5 days before you start
taking an MAOI.
You should not use this medication if you are allergic to milnacipran, or if you have
untreated or uncontrolled narrow-angle glaucoma.
If you have certain conditions, you may need a dose adjustment or special tests to safely take
this medication. Before you take milnacipran, tell your doctor if you have:
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liver or kidney disease;
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heart disease, high blood pressure, heart rhythm disorder;
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seizures or epilepsy;
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glaucoma;
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a bleeding or blood clotting disorder such as hemophilia;
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enlarged prostate, urination problems;
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bipolar disorder (manic depression);
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a history of heavy alcohol use;
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a history of suicidal thoughts or actions; or
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if you are allergic to aspirin or yellow food dye.
You may have thoughts about suicide while taking this medication, especially
if you are younger than 24 years old. Tell your doctor if you have new or worsening depression or
suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.
Your family or other caregivers should also be alert to changes in your mood or symptoms.
Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.
FDA pregnancy category C. It is not known whether milnacipran is harmful to an unborn
baby. Before taking this medication, tell your doctor if you are pregnant or plan to become pregnant
during treatment.
It is not known whether milnacipran passes into breast milk or if it could harm a nursing
baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
Older adults may be more sensitive to the side effects of this medication.
Do not give milnacipran to anyone younger than 17 years old without the advice of a
doctor.
How should I take milnacipran?
Take this medication exactly as it was prescribed for you. Do not take the medication in larger
amounts, or take it for longer than recommended by your doctor. Follow the directions on your
prescription label. Your doctor may occasionally change your dose to make sure you get the best
results from the medication.
You may take medication with or without food. Take the medicine with food if it upsets your
stomach.
Do not stop using milnacipran suddenly, or you could have unpleasant withdrawal
symptoms such as dizziness, anxiety, feeling irritable, confusion, headache, ringing in your ears, and
sleep problems. Talk to your doctor about how to avoid withdrawal symptoms when you stop using
milnacipran.
Store milnacipran at room temperature away from moisture and heat.
What happens if I miss a dose of milnacipran?
Take the missed dose as soon as you remember. However, if it is almost time for the next
regularly scheduled dose, skip the missed dose and take the next one as directed.
Do not
take extra medicine to make up the missed dose.
Where can I get more information about milnacipran?
Your pharmacist has information about milnacipran written for health professionals that you may read.
What are the possible side effects of milnacipran?
Get emergency medical help if you have any of these
signs of an allergic
reaction:
skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have any new or worsening symptoms such as: mood or
behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated,
hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts
about suicide or hurting yourself.
Call your doctor at once if you have any of these serious side effects:
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fast or pounding heartbeats;
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painful or difficult urination;
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easy bruising or bleeding, nosebleeds, bloody or tarry
stools, coughing up blood;
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confusion, hallucinations, severe weakness, seizure
(convulsions);
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high fever, sweating, chills or goose bumps, memory
problems, trouble concentrating, loss of coordination, overactive reflexes, vomiting, diarrhea;
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high blood pressure (severe headache, blurred vision,
buzzing in your ears, chest pain, shortness of breath, uneven heartbeats); or
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stomach pain, loss of appetite, dark urine, clay-colored
stools, jaundice (yellowing of the skin or eyes).
Less serious side effects may include:
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constipation;
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dry mouth, nausea, stomach pain, heartburn, bloating;
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dizziness, drowsiness, headache, tired feeling;
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stuffy nose, sneezing, or other cold symptoms;
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sleep problems (insomnia);
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swelling in your hands or feet;
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hot flashes, sweating, itching, mild skin rash;
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numbness or tingling;
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blurred vision; or
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decreased sex drive, impotence, or difficulty having an
orgasm.
This is not a complete list of side effects and others may occur. Call your
doctor for medical advice about side effects. You may report side effects to FDA at
1-800-FDA-1088. You may report side effects to FDA at 1-800-FDA-1088.
What is the most important information I should know about milnacipran?
Do not take milnacipran together with thioridazine (Mellaril), or a monoamine oxidase
inhibitor (MAOI) such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline
(Eldepryl, Emsam), or tranylcypromine (Parnate). You must wait at least 14 days after stopping an
MAOI before you can take milnacipran. After you stop taking milnacipran, you must wait at least 5
days before you start taking an MAOI.
You may have thoughts about suicide when you first start taking this medication, especially if
you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the
first 12 weeks of treatment.
Call your doctor at once if you have any new or worsening symptoms such as: mood or
behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated,
hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts
about suicide or hurting yourself.
Avoid drinking alcohol while taking milnacipran. Alcohol may increase the risk of damage
to your liver.
Cold or allergy medicine, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine
for seizures, depression, or anxiety can add to sleepiness caused by milnacipran. Tell your doctor if
you regularly use any of these other medicines.
Milnacipran can cause side effects that may impair your thinking or reactions. Be careful if
you drive or do anything that requires you to be awake and alert.
What should I avoid while taking milnacipran?
Avoid drinking alcohol while taking milnacipran. Alcohol may increase the risk of damage
to your liver.
Milnacipran can cause side effects that may impair your thinking or reactions. Be careful if
you drive or do anything that requires you to be awake and alert.
What other drugs will affect milnacipran?
Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers,
and medicine for seizures, depression, or anxiety can add to sleepiness caused by milnacipran. Tell
your doctor if you regularly use any of these medicines.
Talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This
includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Voltaren),
indomethacin, piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), and others. Taking any
of these drugs with milnacipran may cause you to bruise or bleed easily.
Tell your doctor about all other medications you use, especially:
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a blood thinner such as warfarin (Coumadin);
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clonidine (Catapres, Clorpres);
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a diuretic (water pill);
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digoxin (digitalis, Lanoxin);
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epinephrine (Epi-Pen);
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lithium (Lithobid, Eskalith);
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tramadol (Ultram);
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tryptophan (sometimes called L-tryptophan);
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migraine headache medicine such as almotriptan (Axert),
frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex,
Treximet), or zolmitriptan (Zomig); or
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an antidepressant such as citalopram (Celexa), duloxetine
(Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), paroxetine (Paxil), or
sertraline (Zoloft).
This list is not complete and there may be other drugs that can interact with
milnacipran. Tell your doctor about all the prescription and over-the-counter medications you use. This
includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using
a new medication without telling your doctor.
What happens if I have an overdose of milnacipran?
