Milnacipran

Savella is sold in the United States as a racemic mixture of the active dextrorotatory stereoisomer and the inactive levorotatory form.

 

With milnacipran we come full circle in our examination of the pain medicine nee antidepressant. Milnacipran was developed in France as an antidepressant and approved for the use in 1996 and is used for that purpose in over 45 countries worldwide. Milnacipran marketed in the United States as Savella was approved by the FDA in 2009 for the treatment of fibromyalgia, but not depression. It is a member of the serotonin norepinephrine reuptake inhibitor family and shares may similarities with other members of the class.

Major side effects include nausea, headache, dizziness, insomnia, flushing, hyperhidrosis, palpitations, hypertension and dry mouth. As with other SNRIs, sexual side effects and weight gain are less common than with other antidepressants. Serotonin syndrome has been reported but is rare. MAO inhibitors are contraindicated and drugs such as dextromethorphan, tramadol, tapentadol, meperidine and even the triptans should be use with caution.

The elimination half-life of milnacipran is 8 hours twice a day dosing necessary. We use relatively little Savella at Schlesinger Pain Centers, due to its price, especially given its similar efficacy and side effect profile when compared to other members of the class.

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