05 January 2011
Indications
Savella, or the generic milnacipran, is a medication used to treat symptoms related to the chronic pain syndrome Fibromyalgia. It is considered a, “Selective Serotonin and Norepinepherine Reuptake Inhibitor” (SNRI). It works by preventing the reuptake of specific chemical neurotransmitters throughout the body, thereby increasing the amount of Norepinephrine and Serotonin available to the brain. It is thought that blocking the reuptake of these specific “neurotransmitters” resulting pain reduction and improvement in physical function may occur. While some antidepressant medications work in similar ways, Savella is not used in the United States to treat depression or other psychiatric disorders.
Contraindications/Interactions
There are some important medication interactions to be aware of before taking Savella:
- It is important not to take Savella if you are currently taking monoamine oxidase inhibitors (MAOIs). You must wait at least 14 days after stopping a MAOI before you can start taking Savella, as serious and sometimes fatal reactions can occur.
- Medications used to control blood clotting disorders as they may result in an increase in bleeding events.
- Negative effects have been observed when Savella is combined with serotonergic drugs, SSRIs, Triptans, catecholamines, and other drugs that may affect the metabolism of serotonin and dopamine in the body.
You should speak with your physician if you are taking any of these medications.
For patients with narrow-angle glaucoma, the use of Savella is discouraged. Studies have shown that the medication may worsen some symptoms related to the disease.
The use of Savella in individuals under 17 has not been studied, and the use of the medication is not recommended in children.
Adverse Reactions
Side effects include:
- Nausea
- Constipation
- Hot flush
- Excessive sweating
- Vomiting
- Increased heart rate
- Dry mouth
- Insomnia
- Elevated blood pressure
Much like other SNRI’s, some individuals may experience negative psychological side effects, including depression, anxiety, and thoughts of suicide. It is important to speak with your doctor if you begin to develop and change in behavior or symptoms including:
- Thoughts about suicide
- Panic attacks
- Trouble sleeping
- Unusual aggression
- New or worse anxiety
- New or worse depression
- New or worse irritability
There is a chance that Savella may increase blood pressure. It is important to continue to monitor both blood pressure and heart rate while on Savella, and to treat any cardiovascular issues before taking the medication.
Individuals with a history of urethral resistance, or enlarged prostate should use caution while taking Savella, as it may increase renal impairment. Men are more prone to having this side effect.
The effect of Savella during pregnancy is unknown. You should tell your doctor if you are pregnant, or plan to become pregnant while on the medication. It is not known if the medication can pass into breast milk, or harm a nursing infant.
Withdrawal symptoms have been seen in clinical studies. It is important to gradually reduce the use of Savella, and not abruptly stop taking the medication.
Avoid alcohol while taking this medication, as it may increase your chances of liver injury.
Overdose
Acute overdose situations have been reported with and without a combination with other drugs. The most common signs include: high blood pressure, cardio-respiratory arrest, changes in the level of consciousness, confusion, dizziness, and an increase in liver enzymes.
There is no “antidote” to Savella. Acute overdoses should be managed by contacting your local poison control center.
