10 Savella (Milnacipran) Side Effects You Should Know About

If you have fibromyalgia, you know that this condition causes widespread pain throughout the body. It can also cause other symptoms like difficulty sleeping, fatigue, and depression. There’s currently no cure for fibromyalgia, but effective treatments are available.

One such treatment for fibromyalgia pain is Savella (milnacipran). It’s a serotonin and norepinephrine reuptake inhibitor (SNRI) that’s usually taken twice a day. And though Savella can bring effective pain relief, it can also cause many side effects. Here, we’ll cover 10 notable Savella side effects and how to manage them.

1. Nausea

Nausea is the most common Savella side effect. About 1 in 3 people who took Savella in clinical trials reported feeling nauseated after taking it. Less commonly, up to 7% of people also reported vomiting with this medication. These stomach-related side effects tend to get better or go away after your body adjusts to taking Savella.

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In the meantime, there are many tips for managing nausea from Savella at home:

• Take your doses with food.

• Stay hydrated.

• Avoid spicy, fatty, and high-fiber foods.

• Eat smaller meals several times a day, instead of two or three larger meals.

• Try drinking peppermint or ginger tea.

• Ask your pharmacist about safe over-the-counter (OTC) nausea medications to take.

If you throw up shortly after you take Savella, contact your healthcare provider or pharmacist. Depending on how long it’s been, you may need to take another dose. If nausea or vomiting becomes severe or doesn’t seem to get better, let your provider know. There might be another fibromyalgia medication that you’ll tolerate better.

2. Headache

Headaches are another common Savella side effect. Around 1 in 5 people who took Savella in clinical trials reported having headaches. This is another side effect that typically gets better or stops after you’ve been taking the medication for some time.

There are a few things that you can do at home to help manage headaches from Savella:

• Lie down in a quiet, dimly lit room until the headache passes.

• Optimize your sleep routine to make sure you’re getting enough rest.

• Avoid or minimize caffeine and alcohol.

• Try to eat foods and snacks that are high in folic acid (folate) and omega-3 fatty acids.

If these tips don’t seem to help, check with your healthcare provider or pharmacist to see if you can take ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). And if headaches become persistent or severe, let your provider know. This isn’t typical and should be checked out.

3. Constipation

Constipation is also a common Savella side effect. In clinical trials, about 1 in 6 people who took Savella had constipation. Drinking plenty of fluids and eating high-fiber foods may help get things moving again. There are also a variety of OTC constipation medications available. But be sure to ask your healthcare provider first if adding one of these medications would be OK for you.

4. Hot flashes

Hot flashes are a common Savella side effect as well. In clinical trials, around 1 in 8 people who took Savella experienced this. A smaller number of people also experienced body flushing (reddening).

To help combat hot flashes, try wearing loose clothing made from moisture-wicking fabrics. You should also avoid hot beverages or spicy foods. It’s important to drink plenty of water, too. Eating foods that have a high water content, such as cucumbers and berries, can help you hydrate even better.

Let your healthcare provider know if your hot flashes are persistent or too bothersome. They may have additional suggestions to help with this Savella side effect. They may also recommend trying a different fibromyalgia treatment.

5. Dizziness

Dizziness is also common when taking Savella. In clinical trials, about 1 in 10 people who took Savella reported dizziness as a side effect. This feeling may be more noticeable when first starting the medication. It typically gets better or goes away with time.

If you’re experiencing dizziness with Savella, try these tips to help manage it:

• Sit or lie down to let the dizziness pass.

• Drink a glass of water.

• Change positions (like from sitting to standing) slowly to help prevent falling.

If dizziness becomes severe or you pass out, contact your healthcare provider. They can evaluate the situation and see if there’s another underlying cause.

6. Excessive sweating

Excessive sweating is a less common Savella side effect than those listed above. But it can raise your risk of dehydration if it happens to you. This is especially true during the summer months or if you live in a warmer climate.

Similar to managing hot flashes, wearing loose clothing and avoiding spicy foods may help with sweating. And be sure to stay well hydrated. There are also OTC and prescription-strength antiperspirants available to help with underarm sweating.

If sweating becomes excessive, check in with your healthcare provider. There are treatments available that can help lower the amount of sweat you make. These could be helpful if Savella is otherwise working well for you.

7. Heart palpitations

Heart palpitations are a less common Savella side effect. This could feel like a pounding or fluttering in your chest.

In some cases, palpitations are harmless and only happen occasionally. But they could also mean your blood pressure or heart rate are elevated (a more serious Savella side effect). It’s important to reach out to your healthcare provider if you experience palpitations with Savella. They can examine your heart and determine if it’s safe for you to keep taking the medication.

However, you should go to the nearest emergency room if your heart palpitations last longer than a few minutes at a time or are accompanied by symptoms like shortness of breath or chest pain.

8. Suicidal thoughts

Like other antidepressants, Savella contains a boxed warning (the strictest warning the FDA can give a medication) for suicidal thoughts. This side effect is rare, but serious. The risk of suicidal thoughts is higher for people under 25 years old and those with a history of mental health conditions. This risk is similar to that of other SNRIs.

You should watch for changes in your mood or behavior while taking Savella. Contact your healthcare provider immediately if you experience any thoughts of suicide.

If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.

9. High blood pressure and fast heart rate

Savella also contains a warning for high blood pressure and a faster heart rate. Some people have developed hypertension (chronic high blood pressure) while taking Savella. These heart-related side effects were fairly uncommon. But they may be more concerning if you already have hypertension or issues with your heart rate.

Ask your healthcare provider if you should monitor your blood pressure and heart rate while taking Savella. If you have a history of any heart problems, make sure your provider is aware of them before starting the medication. They may suggest an alternative treatment.

10. Liver damage

Savella can also cause liver damage. In clinical trials, liver function tests worsened slightly in 6% to 7% of people. These changes didn’t lead to any long-term liver problems.

But in rare cases, severe liver damage happened to people taking this medication. Symptoms of liver damage can include vomiting, stomach pain, and yellowing of the skin or eyes (jaundice).

Your healthcare provider will likely monitor your liver function while taking Savella. If you have a history of liver problems, let your healthcare provider know before starting this medication.

When should I contact my healthcare provider about Savella (milnacipran) side effects?

When you should contact your healthcare provider about side effects depends on your symptoms. For severe side effects, you should contact your healthcare provider right away.

For example, if you notice changes in mood or behavior, you should speak with your healthcare provider immediately. You should also contact them if you have a racing heartbeat, severe vomiting, or severe flushing.

For less serious side effects, like nausea or constipation, you can try managing them at home. You may be able to relieve these with OTC medications or lifestyle changes. If your side effects worsen, or if they’re interfering with your daily routine, talk to your healthcare provider.

You should also contact your healthcare provider if you’re thinking of stopping Savella. Like with other SNRIs, you can have withdrawal effects from stopping the medication abruptly. Your healthcare provider can provide you instructions on how to safely stop Savella.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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