Milnacipran

Milnacipran is used to treat chronic pain caused by fibromyalgia (a medical condition that leads to long-term pain in the muscles and joints).

Milnacipran may also be used for reasons not mentioned in this medication guide.

Follow all instructions on your prescription label and read any medication guides or instruction sheets. Your doctor may change your dose from time to time. Use the medicine exactly as directed. Inform your doctor if you feel a stronger urge to take more of milnacipran.

You can take the medicine with or without food, but eating may help you handle the medicine better.

Your blood pressure and heart rate will need to be checked regularly.

Tell your doctor if you notice any changes in sexual function, like loss of interest in sex, difficulty reaching orgasm, or (for men) issues with erections or ejaculation. Some sexual problems can be treated.

Do not stop using milnacipran suddenly, or you might experience unpleasant withdrawal symptoms. Ask your doctor how to safely stop using milnacipran.

Store at room temperature, away from moisture and heat.

Some young people may have thoughts about suicide when they first start taking milnacipran. Be aware of any changes in your mood or symptoms.

Do not use milnacipran if you have taken an MAO inhibitor in the past 14 days, such as isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine. After you stop taking milnacipran, you must wait at least 5 days before starting an MAOI.

Milnacipran is not approved for use by anyone younger than 18 years old.

Do not stop taking milnacipran without first consulting your doctor.

You should not use milnacipran if you are allergic to it.

Do not use milnacipran if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could happen. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine. After you stop taking milnacipran, you must wait at least 5 days before you start taking an MAOI.

Milnacipran should not be given to a child younger than 18 years old.

Tell your doctor if you have ever had:

• liver disease;
• kidney disease;
• heart disease, high blood pressure;
• seizures or epilepsy;
• bipolar disorder (manic depression);
• bleeding problems;
• low levels of sodium in your blood;
• sexual problems;
• if you drink alcohol; or
• if you take a blood thinner such as warfarin (Coumadin, Jantoven).

Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. These medicines may interact with milnacipran and cause a serious condition called serotonin syndrome.

Some young people have thoughts about suicide when they first start taking milnacipran. Your doctor should monitor your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Taking this medicine during pregnancy may cause serious lung problems or other complications in the baby. Tell your doctor right away if you become pregnant. Do not start or stop taking this medicine during pregnancy without your doctor's advice.

If you are pregnant, your name may be added to a pregnancy registry to track the effects of milnacipran on the baby.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risks.

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: changes in mood or behavior, depression, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Milnacipran may cause serious side effects. Call your doctor immediately if you have:

• little or no urination;
• blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• a seizure;
• feeling light-headed, like you might pass out;
• liver problems—stomach pain (upper right side), itching, dark urine, jaundice (yellowing of the skin or eyes);
• low sodium level—headache, confusion, severe weakness, vomiting, problems with thinking or memory, feeling unsteady; or
• manic episodes—racing thoughts, increased energy, unusual risk-taking behavior, extreme happiness, being irritable or talkative.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Some side effects may be more likely in older adults.

Common side effects of milnacipran may include:

• nausea, vomiting, constipation;
• dry mouth;
• increased blood pressure;
• fast or pounding heartbeats;
• increased sweating, flushing (warmth, redness, or tingly feeling);
• headache, dizziness; or
• trouble sleeping.

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.

Usual Adult Dose for Fibromyalgia:

Maintenance dose: 50 mg orally 2 times a dayMaximum dose: 100 mg orally 2 times a day (200 mg orally per day)Comments:-Dosing may be titrated according to the following schedule:-Initial dose on day 1: 12.5 mg orally once-Days 2 and 3: 12.5 mg orally 2 times a day-Days 4 through 7: 25 mg orally 2 times a day-After day 7: 50 mg orally 2 times a dayUse: Management of fibromyalgia

Take the medicine as soon as you remember, but skip the missed dose if it's nearly time for your next dose. Do not take two doses at once.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include extreme drowsiness, slow heart rate, weak pulse, fainting, and slow breathing (breathing may stop).

Avoid driving or hazardous activity until you know how milnacipran will affect you. Your reactions could be impaired.

Avoid drinking alcohol.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with milnacipran may cause you to bruise or bleed easily.

Using milnacipran with other medications that cause drowsiness can increase this effect. Consult your doctor before taking opioid medication, a sleeping pill, a muscle relaxer, or medicines for anxiety or seizures.

Other medications may impact how milnacipran works, including prescription and over-the-counter drugs, vitamins, and herbal products. Inform your doctor about all the medications you are currently taking and any new medications you begin or stop using.