Savella is a selective serotonin and norepinephrine reuptake inhibitor (SNRI). It is similar to drugs used to treat depression and other psychiatric disorders. In January 2009, the FDA approved Savella to help manage fibromyalgia in adults. Available by prescription, it is the first drug introduced just for this purpose.
Previous drugs approved to manage fibromyalgia include Lyrica (pregabalin), a nerve pain and epilepsy drug, and Cymbalta (duloxetine), another SNRI. Milnacipran affects certain chemicals in the brain called neurotransmitters. An abnormality in these chemicals is thought to be related to fibromyalgia. Milnacipran is not used to treat depression but how it works in the body is similar to how some antidepressants work.
Newest fibromyalgia drug
Milnacipran HCI (Savella) is the newest fibromyalgia drug. It was approved in 2009. It was also the first drug made just to treat fibromyalgia. This drug is not prescribed to treat depression, but it works like drugs that do treat depression. Milnacipran HCI changes the levels of serotonin and norepinephrine in your brain. This may help relieve pain.
Increase risk of suicidal thinking
Savella is a selective serotonin and norepinephrine reuptake inhibitor (SNRI), similar to some drugs used for the treatment of depression and other psychiatric disorders. Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of such drugs in a child, adolescent, or young adult must balance this risk with the clinical need.
Savella is not approved for use in the treatment of major depressive disorder. Savella is not approved for use in pediatric patients. You may have thoughts about suicide when you first start taking this medication, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.
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Drug interactions
Do not take milnacipran together with thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as isocarboxazid(Marplan), phenelzine(Nardil), rasagiline (Azilect), selegiline(Eldepryl, Emsam), (Parnate). You must wait at least 14 days after stopping an MAOI before you can take milnacipran.
After you stop taking milnacipran, you must wait at least 5 days before you start taking an MAOI. You should not use this medication if you are allergic to milnacipran, or if you have untreated or uncontrolled narrow-angle glaucoma.
Effect of savella on fatigue
An antidepressant, milnacipran is one of three drugs that have been approved by the Food and Drug Administration to treat fibromyalgia. While relief of fibromyalgia pain can help people feel less fatigued, milnacipran appears to have an additional effect on fatigue separate from that associated with pain relief.
Recommended dose
The recommended dose of Savella is 100 mg/day (50 mg twice daily). avella may interact with blood thinners, clonidine, diuretics (water pills), digoxin, epinephrine,lithium, tramadol, tryptophan, medicine, migraine or antidepressants.
Savella is a tablet. You take Savella in two divided doses each day. You start at 12.5 milligrams on the first day. Then you increase to 100 milligrams/day over a one-week period. Although the recommended dose is 100 milligrams/day, your doctor may increase it to 200 milligrams/day, based on your response to the medication.
Do not stop using milnacipran suddenly, or you could have unpleasant withdrawal symptoms such as dizziness, anxiety, feeling irritable, confusion, headache, ringing in your ears, and sleep problems. Talk to your doctor about how to avoid withdrawal symptoms when you stop using milnacipran.
Withdrawal symptoms
Tell your doctor all medications you are taking. During pregnancy, Savella should be used only when prescribed. Babies born to mothers who have used this drug during the last 3 months of pregnancy may infrequently develop withdrawal symptoms such as feeding/breathing difficulties, seizures, muscle stiffness, or constant crying. If you notice any of these symptoms in your newborn, tell the doctor.
It is unknown if this medication passes into breast milk. Discuss the risks and benefits with your doctor before breastfeeding. Do not stop using Savella suddenly, or you could have withdrawal symptoms such as dizziness, anxiety, feeling irritable, confusion, headache, ringing in your ears, and sleep problems.
Precautions
Do not drive or use machinery until you are certain Savella is not affecting your mental or physical abilities. Avoid drinking alcohol. Talk with your doctor before stopping Savella and do not stop suddenly; this can cause withdrawal symptoms. Be sure to let your doctor know if you begin taking any other medications, including over-the-counter drugs.
Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.
Mechanism of action
Savella allows more of these neurotransmitters to travel from neuron to neuron. It is not exactly clear how Savella works. But increasing levels of neurotransmitters may ease pain and reduce fatigue or help with memory. However, not all these benefits have been tested in humans. With fibromyalgia, you may have a lower threshold for pain. Experts believe this may result from changes in your nervous system. These changes may cause you to be more sensitive to pain. This could result from the wrong levels of neurotransmitters. These are chemicals in your brain.
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Common side effects
Call your doctor at once if you have any of these serious side effects:
- > Chills or goose bumps, memory problems, trouble concentrating,
- > Agitation, hallucinations, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting;
- >very stiff (rigid) muscles, high fever, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out;
- > High blood pressure (severe headache, blurred vision, buzzing in your ears, chest pain, shortness of breath, uneven heartbeats)
Also Read: 9 Dangerous Prescription Drugs You Should Think Twice Before Taking
References:
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Savella May Reduce Pain, Alter Brain Activity in Fibromyalgia Patients, Study Suggests via BY
- The study, “Using fMRI to evaluate the effects of milnacipran on central pain processing in patients with fibromyalgia,” appeared in the Scandinavian Journal of Pain.