Savella (Milnacipran) – Oral

Warning:

Taking Savella (milnacipran) may increase the risk of suicidal ideation, thoughts, or behavior in children, adolescents, and young adults who are being treated for psychiatric disorders. Savella is not approved for children.

What Is Savella?

Savella (milnacipran) is an oral prescription drug that belongs to a class of medications called selective serotonin-norepinephrine reuptake inhibitors (SNRIs). It is used to treat a condition called fibromyalgia in adults.

Norepinephrine and serotonin are neurotransmitters (signaling molecules) in the brain and the rest of the nervous system. SNRIs increase the amounts of these neurotransmitters by stopping their breakdown or transport. This drug class usually treats depression and other psychological disorders. However, Savella is used to manage fibromyalgia, a chronic condition that causes pain, fatigue, and other symptoms.

Savella is available in tablet form.

Drug Facts

Generic Name: Milnacipran

Brand Name(s): Savella

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Central nervous system agent

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Milnacipran HCl

Dosage Form(s): Tablet

What Is Savella Used For?

Savella is used to treat fibromyalgia, a condition that causes widespread pain, fatigue, and other symptoms. The cause of fibromyalgia is unknown, but it is believed to be due to an abnormality in how your brain processes pain signals. In clinical trials, people taking Savella reported less pain and improved physical function.

Savella (Milnacipran) Drug Information: A person has a hand on their neck wincing in pain with their brain showing and neurotransmitters

Verywell / Dennis Madamba

How to Take Savella

Take Savella precisely as prescribed by your healthcare provider. You can take it with or without food, though you might find it easier to take it with a meal.

Savella is available in 12.5 milligram (mg), 25 mg, 50 mg, and 100 mg tablets. Depending on how well you tolerate the medication, your healthcare provider may start you at a low dose (12.5 mg) and ramp up the dose over the first week of therapy.

The usual goal is to take 100 mg per day, divided into two doses. If the need arises, this may be increased to 200 mg per day, though doses higher than that have not been studied.

Storage

Savella is supplied in bottles or titration packs, blister packs that contain several different dosages and allow you to increase your dose as needed at the beginning of therapy. Store the pills at room temperature (about 68 to 77 degrees Fahrenheit), although you may briefly expose them to temperatures of 59–86 degrees. As with other medications, remember to keep Savella out of reach of children and pets to prevent accidental consumption.

Off-Label Uses


Healthcare providers may prescribe Savella for off-label uses, meaning for conditions not specifically indicated by the Food and Drug Administration (FDA). Because Savella works the same way as certain other antidepressants, it may be used off-label to treat major depressive disorder (MDD) and other psychiatric conditions.

What Are the Side Effects of Savella?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other symptoms, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The most common side effect of Savella is nausea. Other common side effects include:

  • Headache
  • Constipation
  • Dizziness
  • Insomnia
  • Hot flashes
  • Excessive sweating
  • Vomiting
  • Dry mouth

Severe Side Effects

Severe side effects may include:

  • Increased blood pressure or heart rate
  • Seizures or convulsions
  • Liver problems
  • Low sodium levels
  • Abnormal bleeding or bruising
  • Manic episodes
  • Problems urinating
  • Vision problems

Other antidepressants like Savella have been associated with increased suicidal thoughts in children, adolescents, and young adults. People who are started on this medication should be closely monitored for suicidal thoughts or other changes in behavior.

Drugs like Savella increase serotonin levels in your body and are associated with a small risk of serotonin syndrome, an uncommon condition that can be serious or life-threatening. Signs of serotonin syndrome include:

  • Changes in mental status like agitation or hallucinations
  • Coordination problems and muscle twitching
  • Muscle rigidity
  • Dizziness
  • Sweating
  • Fever
  • Tremor

Call your healthcare provider immediately if you think you have symptoms related to serotonin syndrome.

Report Side Effects

Savella may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Savella Should I Take?

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The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For treatment of fibromyalgia:
      • Adults—At first, 12.5 milligrams (mg) once a day on Day 1. 12.5 mg 2 times a day on Days 2 to 3. 25 mg 2 times a day on Days 4 to 7. 50 mg 2 times a day after Day 7. Your doctor may adjust your dose as needed. However, the dose is usually not more than 200 mg per day.
      • Children—Use and dose must be determined by your doctor.

Modifications

You may need a dose reduction if you have severe kidney disease. No dosage adjustment is necessary for those with mild kidney or liver impairment.

Several drugs interact with Savella, and combined therapy may require you to adjust your dose. Make sure your healthcare provider knows all the drugs and supplements you are taking before starting therapy with Savella.

Additionally, stopping Savella can result in withdrawal symptoms. If you are discontinuing this medication after extended use, your healthcare provider will wean you off of it with a tapered dosage schedule.

Missed Dose

If you miss a dose of Savella, skip the missed dose and take your next dose at the regular time.

Overdose: What Happens if I Use Too Much Savella?

Get medical help or call poison control if you accidentally take too much Savella. Let your healthcare provider know what other drugs you are taking, as some combinations of drugs can make Savella overdoses more dangerous.

Common signs and symptoms of an overdose include:

  • Increased blood pressure
  • Cardio-respiratory arrest
  • Changes in consciousness
  • Confusion
  • Dizziness
  • Increased liver enzymes

What Happens If I Overdose on Savella?

If you think you or someone else may have taken too much Savella, call a healthcare provider or the Poison Control Center (800-222-1222).

If you or someone else experiences signs of a Savella overdose, call 911 immediately.

Precautions

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It is important that your doctor check your progress at regular visits to allow for changes in your dose and to help reduce any side effects. Blood and urine tests may be needed to check for any unwanted effects.

Milnacipran may cause some teenagers and young adults to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Some people may have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. If you or your caregiver notice any of these unwanted effects, tell your doctor right away. Let the doctor know if you or anyone in your family has bipolar disorder (manic-depressive) or has tried to commit suicide.

Do not take this medicine during 14 days after stopping a monoamine oxidase inhibitor (MAOI) (eg, isocarboxazid [Marplan®], linezolid [Zyvox®], methylene blue injection, phenelzine [Nardil®], selegiline [Eldepryl®], or tranylcypromine [Parnate®]). Do not take an MAO inhibitor for at least 5 days after stopping milnacipran. Talk to your doctor about this if you have questions.

Make sure your doctor knows if you are also using aspirin, NSAIDs (eg, ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, Motrin®), or a blood thinner (eg, warfarin, Coumadin®). Milnacipran may increase your risk of bleeding problems when taken together with these medicines.

This medicine may cause a serious condition called serotonin syndrome when taken with certain medicines such as St. John's wort, buspirone, fentanyl, lithium, tryptophan, amphetamines, other medicines to treat depression, or some pain or migraine medicines (eg, rizatriptan [Maxalt®], sumatriptan [Imitrex®], tramadol [Ultram®], or zolmitriptan [Zomig®]. Check with your doctor first before taking any other medicines. Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there.

You will also need to have your blood pressure and pulse measured before starting and while you are using this medicine. If you notice any change to your recommended blood pressure or pulse rate, call your doctor right away. If you have questions about this, talk to your doctor.

Check with your doctor right away if you have clay-colored stools, dark urine, decreased appetite, fever, headache, itching, loss of appetite, nausea and vomiting, skin rash, stomach pain or tenderness, swelling of the feet or lower legs, unusual tiredness or weakness, or yellow eyes or skin. These may be symptoms of a serious liver problem.

Avoid drinking alcohol while you are using this medicine.

This medicine may cause some people to become less alert than they are normally. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine may cause hyponatremia (low sodium in the blood). This is more common in elderly patients, those who are taking diuretic medicines for high blood pressure, or those who have decreased amounts of fluid in the body due to severe diarrhea or vomiting. Check with your doctor right away if you have confusion, headache, memory problems, trouble concentrating, weakness, or feel unsteady when standing.

Do not stop using this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely to decrease the chance of side effects, including actions that are out of control, agitation, anxiety, confusion, continuing ringing or buzzing or other unexplained noise in the ears, dizziness, headache, hearing loss, irritability, nervousness, seizures, talking, feeling, and acting with excitement, trouble sleeping, or unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness.

Check with your doctor right away if you have decreased interest in sexual intercourse, delayed or inability to have and orgasm in women, inability to have or keep an erection in men, or loss in sexual ability, desire, drive, or performance. These could be symptoms of sexual dysfunction.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

What Are Reasons I Shouldn’t Take Savella?

You should not take Savella if you are allergic to milnacipran or any of Savella's ingredients.

Further, you should not take Savella with any drugs in the monoamine oxidase inhibitor (MAOI) class or if you have taken any MAOIs recently. MAOIs are an older class of antidepressants that can increase the risk of serotonin syndrome when taken with Savella. The antibiotic Zyvox (linezolid) is also a member of this class, so you should avoid taking this medication. Let your healthcare providers know that you are taking Savella.

Tell your healthcare provider if you are pregnant, plan to become pregnant, or are breastfeeding. Whether Savella can harm the fetus or a breastfeeding infant is not known.

What Other Medications Interact With Savella?

Savella increases serotonin levels in the body. Therefore, it is associated with a small risk of serotonin syndrome. Avoid combinations of drugs that increase serotonin levels, which can further increase the risk.

Other drugs that increase serotonin include:

  • Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), including Prozac (fluoxetine) or Celexa (citalopram); tricyclic antidepressants, such as Elavil (amitriptyline) or Pamelor (nortriptyline); and MAOIs
  • Migraine drugs, known as triptans
  • Lithium, which is often used for bipolar disorder
  • Zyvox (linezolid)
  • Saint-John's-wort, an herbal supplement often used to treat depression

Savella may also interfere with the activity of platelets (red blood cells that help to clot blood). Taking Savella with other antiplatelet drugs, such as aspirin or ibuprofen, can increase your bleeding risk. Anticoagulants like Lovenox (heparin) or Jantoven (warfarin) can also increase this risk and should be monitored or adjusted when taken with Savella.

It is also essential to know that heavy alcohol intake can worsen the side effects of Savella. Talk to your healthcare provider about how much alcohol you drink before starting therapy.

Make sure your prescribing healthcare provider knows all the medications, herbs, and supplements you take.

What Medications Are Similar?

Savella is a member of a drug class called serotonin-norepinephrine reuptake inhibitors (SNRIs). While Savella is used to treat fibromyalgia, not depression, other SNRIs are often used as antidepressants and for other psychological disorders.

Other commonly used SNRIs include:

Fetzima (levomilnacipran) is another drug chemically similar to Savella that is used to treat major depression.

Frequently Asked Questions

  • What is Savella used for?

    Savella is used to treat fibromyalgia, a condition that causes widespread pain, fatigue, and other symptoms. The cause of fibromyalgia is unknown, but it is believed to be due to an abnormality in how your brain processes pain signals. Clinical trials have shown that Savella can improve pain and physical function in people with this condition.

  • How does Savella work?

    Savella is a selective serotonin-norepinephrine reuptake inhibitor (SNRI). Norepinephrine and serotonin are neurotransmitters (signaling molecules) in the brain. SNRIs increase the amounts of these neurotransmitters by stopping their breakdown or transport. It is believed that this can improve the symptoms of fibromyalgia.

    Savella is not an antidepressant, but other members of the SNRI drug class are used to treat depression and other psychological disorders.

  • What are the side effects of Savella?

    The most common side effect of Savella is nausea. Other side effects include headaches, constipation, dizziness, insomnia, hot flashes, excessive sweating, vomiting, palpitations, increased heart rate, dry mouth, and blood pressure.

    Drugs in the same class as Savella have been associated with increased suicidal thoughts in children, adolescents, and young adults. People who are started on Savella should be closely monitored for suicidal thoughts or other changes in behavior.

    Drugs like Savella can also increase serotonin levels in your body. Savella is associated with a small risk of serotonin syndrome, an uncommon condition that can be serious or life-threatening.

How Can I Stay Healthy While Taking Savella?

Science's understanding of fibromyalgia continuously improves as healthcare professionals find new ways to recognize and treat the disease. Until relatively recently, there were few effective treatments for fibromyalgia. But now, drugs like Savella can reduce pain and allow you to increase activity in your day-to-day life.

While drug treatments like Savella can significantly improve your symptoms, therapy doesn't need to stop there. You may want to attack the disease on multiple fronts. Alternative therapies like an exercise program, acupuncture, and massage therapy can bring tremendous benefits.

Remember, patients do best when they can advocate for themselves. Don’t be afraid to ask your healthcare provider about the availability of alternative therapies in addition to pharmaceutical options.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Savella label.

  2. Gupta H, Girma B, Jenkins JS, et al. Milnacipran for the treatment of fibromyalgia. Health Psychology Research. 2021;9(1). doi:10.52965/001c.25532

  3. Nakagawa A, Watanabe N, Omori IM, et al. Efficacy and tolerability of milnacipran in the treatment of major depression in comparison with other antidepressants. CNS Drugs. 2012; 22, 587-602. doi:10.2165/00023210-200822070-00004

  4. Siracusa R, Di Paola R, Cuzzocrea S, Impellizzeri D. Fibromyalgia: Pathogenesis, mechanisms, diagnosis and treatment options update. Int. J. Mol. Sci. 2021, 22(8), 3891; doi:10.3390/ijms22083891

By Rony Kampalath, MD
Rony Kampalath, MD, is board-certified in diagnostic radiology and previously worked as a primary care physician. He is an assistant professor at the University of California at Irvine Medical Center, where he also practices. Within the practice of radiology, he specializes in abdominal imaging.