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Milnacipran HCL (Savella)

A dual-Reuptake inhibitor.

Selective serotonin and norepinephrine reuptake inhibitor(SNRI).

Has a threefold great efficacy in inhibiting norepinephrine reuptake in vitro compared to serotonin reuptake.

Serotonin and norepinephrine neurotransmitters exert modulatory effects on peripheral and central pain processing.

Dual reuptake agents have greater analgesic effects then compounds that selectively raise serotonin.

Metabolites of norepinephrine and serotonin are reduced in the CSF of patients with fibromyalgia.

Associated There with an increased risk of suicidal thinking and behavior in children, adolescents and young adults.

Used for the management of fibromyalgia.

Contraindicated in patients taking monoamine oxidase inhibitors.

Contraindicated in patients with uncontrolled narrow-angle glaucoma.

Recommended dose is 100 mg per day as 50 mg PO BID.

Recommended dosing is 12.5 milligrams, day one, 25 mg per day days two through three, 50 mg a day days four through seven and the hundred milligrams a day after day seven.

Most frequent adverse reactions include nausea, headache, constipation, dizziness, insomnia, hot flashes, hyperhidrosis, vomiting, palpitations, tachycardia, dry mouth, and hypertension.

May increase the risk of bleeding events and the males may increase obstructive uropathy symptoms.

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