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What Is Milnacipran?

By Jacquelyn Gilchrist
Updated May 17, 2024
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Milnacipran is a drug prescribed to treat symptoms of fibromyalgia, a chronic condition that causes widespread pain. In countries outside the United States, this drug may also be used to treat depression. It is a selective serotonin and norepinephrine reuptake inhibitor (SNRI), which means that it works to elevate the levels of certain natural substances in the brain to calm nerve impulses that relay pain signals.

Typically, patients will begin with a low dose of milnacipran. Those who require a higher dose can gradually increase the amount for a total of no more than 200 milligrams (mg) daily. Most patients will take about 100 mg in two separate doses of 50 mg each. Those who have an upset stomach with this medicine should take it with food. Abruptly discontinuing milnacipran can result in withdrawal symptoms, such as insomnia, mood changes, and in severe cases, seizures.

People will likely undergo routine tests to monitor the body's response to the drug. These can include liver function checks and blood pressure monitoring. The doctor should advise elderly patients that they are more susceptible to developing side effects from milnacipran. Children younger than 17 years old should not take this drug, because safety has not been established as of 2011.

Some side effects may occur with the use of milnacipran, which should be discussed with the doctor if they become bothersome. Flushing, insomnia, and increased sweating may sometimes occur. Patients may experience nausea, vomiting, and loss of appetite. Dizziness, blurred vision, and decreased libido have been reported. Men may sometimes experience swollen or painful testicles.

Patients should get immediate medical help if they experience more serious side effects. These are uncommon, but may include hallucinations, seizures, and loss of consciousness. Problems concentrating, unsteady walking, and fainting may also occur. Other patients have reported bloody vomit, bloody stools, and nosebleeds, as well as vomit that has the appearance of coffee grounds. Very small red spots under the skin, jaundice, and flu-like symptoms have also occurred.

Serotonin syndrome is a possible complication of milnacipran. This condition occurs when a patient has too much serotonin and it may potentially be fatal. Symptoms of serotonin syndrome can include rapid or irregular heartbeat, coma, and tremors, along with hallucinations or a fever. In addition, patients under the age of 24 may very rarely develop suicidal tendencies with the use of this type of medication.

Before taking milnacipran, patients must disclose their other medical conditions, medications, and supplements. Those who are pregnant or breastfeeding should inform the doctor, along with patients who have glaucoma, heart problems, or a history of mental illness. Milnacipran may interact with drugs such as blood thinners, diuretics, and epinephrine. It may also interact with supplements like tryptophan, St. John's wort, and 5-HTP.

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