Savella
Savella (milnacipran) is FDA approved to manage fibromyalgia in adults. It belongs to the drug class called serotonin and norepinephrine reuptake inhibitors (SNRIs). Savella (milnacipran) is a tablet that's taken by mouth twice a day. You'll usually follow a dosing schedule for the first few days to reach the right dose for you. Side effects can include nausea, constipation, headache, and dizziness. As of January 2025, Savella (milnacipran) is only available as a brand-name medication. There's no generic version yet.
What is Savella (milnacipran)?
What is Savella (milnacipran) used for?
How Savella (milnacipran) works
Savella (milnacipran) is a serotonin and norepinephrine reuptake inhibitor (SNRI). It’s not clear how the medication helps with fibromyalgia. But it raises the amount of serotonin and norepinephrine in the brain. These chemicals play a role in regulating pain.
Drug facts
Side effects of Savella (milnacipran)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nausea (37%)
- Headache (18%)
- Constipation (16%)
- Trouble falling and staying asleep (insomnia, 12%)
- Sudden feeling of warmth (hot flush, 12%)
- Dizziness (10%)
Less Common Side Effects
- Vomiting
- Dry mouth
- Sweating a lot
- Migraine
- Upper respiratory infection
- Racing heart or fast heart rate
- High blood pressure
- Sexual problems (a lower sex drive; problems with erections, ejaculations, or orgasms)
Savella (milnacipran) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Suicidal thoughts or behaviors
- Serotonin syndrome: fever, sweating, movement problems, distress, hallucinations
- Liver damage: yellowing of your skin or eyes, pain in your upper stomach, dark urine
- Low sodium levels: headache, difficulty concentrating, memory problems, confusion, weakness, unsteadiness, hallucinations, fainting, seizures
- Bleeding or bruising: unusual bleeding or bruising, bleeding or bruising that doesn't go away, nosebleeds, blood in your urine or stool
- Seizure
More on Savella (milnacipran) side effects
The following Savella (milnacipran) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Blurred vision
body aches or pain
chills
difficulty with breathing
dizziness
ear congestion
fast, irregular, pounding, or racing heartbeat or pulse
fear or nervousness
headache
increased sweating
loss of voice
pounding in the ears
slow or fast heartbeat
unusual tiredness or weakness
Less common
Back pain
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
chest pain or discomfort
chills
decrease in frequency of urination
decrease in urine volume
difficult or painful urination
difficulty in passing urine (dribbling)
groin pain
muscle aches
pain or burning with urination
shakiness in the legs, arms, hands, or feet
swollen, tender prostate
tightness in the chest
Rare
Bladder pain
bloating or swelling of the face, arms, hands, lower legs, or feet
bloody or cloudy urine
bruise
discouragement
fall
feeling sad or empty
frequent urge to urinate
full or bloated feeling
increased or decreased weight
irritability
lack of appetite
loss of interest or pleasure
lower back or side pain
pressure in the stomach
rapid weight gain
swelling of the abdominal or stomach area
tingling of the hands or feet
tiredness
trouble concentrating
trouble sleeping
unusual weight gain or loss
vomiting
Incidence not known
Agitation
black, tarry stools
bleeding gums
blistering, peeling, or loosening of the skin
blood in the urine or stools
coma
confusion as to time, place, or person
convulsions
dark-colored urine
decreased urine output
difficulty with swallowing
general tiredness and weakness
high fever
holding false beliefs that cannot be changed by fact
increased sweating
increased thirst
joint or muscle pain
light-colored stools
loss of balance control
loss of consciousness
mask-like face
muscle cramps or spasms
muscle pain or stiffness
overactive reflexes
pinpoint red spots on the skin
poor coordination
red skin lesions, often with a purple center
red, irritated eyes
restlessness
seeing, hearing, or feeling things that are not there
seizures
severe muscle stiffness
shuffling walk
slowed movements
slurred speech
sores, ulcers, or white spots on the lips or in the mouth
stiffness of the arms and legs
sweating
swelling of the face, ankles, fingers, or lower legs
swollen glands
talking or acting with excitement you cannot control
tic-like (jerky) movements of the head, face, mouth, and neck
tiredness
trembling and shaking of the fingers and hands
twitching
unusual bleeding or bruising
unusual excitement, nervousness, or restlessness
unusually pale skin
upper right abdominal or stomach pain
yellow eyes and skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Feeling of warmth
headache, severe and throbbing
redness of the face, neck, arms, and occasionally, upper chest
sudden sweating
Less common
Abdominal or stomach pain
change or problem with discharge of semen
decreased appetite
decreased interest in sexual intercourse
inability to have or keep an erection
loss in sexual ability, desire, drive, or performance
not able to ejaculate semen
rash
swelling of the testes
Rare
Acid or sour stomach
belching
bloated
change in taste
excess air or gas in the stomach or intestines
full feeling
indigestion
irritability
loss of taste
night sweats
passing gas
sleepiness or unusual drowsiness
stomach discomfort or upset
Incidence not known
Swelling of the breasts or unusual milk production
unexpected or excess milk flow from the breasts
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Savella (milnacipran)
Pros
- One of few medications approved for fibromyalgia
- Can take with or without food
Cons
- Taken every day to help with fibromyalgia pain over time, not just "as needed" for quick relief
- Not approved for children
Pharmacist tips for Savella (milnacipran)
- You can take Savella (milnacipran) with or without food. Taking it with food might help with upset stomach, which is a common side effect of the medication.
- Follow the instructions from your prescriber and pharmacist on how to take Savella (milnacipran). The dosing schedule helps you slowly raise your dose over a week to reach your maintenance dose.
- Savella (milnacipran) can sometimes make you dizzy and affect how well you can focus. Don't drive or do anything that you need to pay attention for until you know how the medication affects you. Don't drink alcohol while you're taking Savella (milnacipran) because it can make these side effects more intense.
- Don't lower your dose or stop taking Savella (milnacipran) without talking to your prescriber first. Lowering your dose or stopping the medication suddenly can cause withdrawal symptoms. They can include mood swings, headache, trouble sleeping, and in serious cases seizure. To prevent withdrawal symptoms, your prescriber will help you stop the medication slowly over time.
- Continue to exercise regularly and get enough sleep while you're taking Savella (milnacipran). These lifestyle changes can help make your fibromyalgia more manageable. Ask your prescriber about other ways to help with your fibromyalgia.
Common questions about Savella (milnacipran)
Savella (milnacipran) is only approved to treat fibromyalgia. Researchers have studied its use for depression, but results have been mixed. One large study couldn't draw clear conclusions about how well it works or how safe it is for depression. But some studies found that milnacipran might work as well as tricyclic antidepressants (TCAs) like amitriptyline. Others also showed that milnacipran might work better than selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft). Keep in mind that taking Savella (milnacipran) for depression is off-label. Talk to your primary care provider or psychiatrist about treatment options for depression.
No, Savella (milnacipran) isn't a controlled substance. The medication isn't known to have a risk of physical and mental dependence.
Hair loss wasn't reported in clinical studies of Savella (milnacipran). But some common antidepressants in the same drug class (SNRIs) have been linked to hair loss. Talk to your prescriber if you notice hair thinning or hair loss while you're taking Savella (milnacipran). They can help you find ways to manage it.
No, Savella (milnacipran) doesn't tend to cause weight gain. In a clinical study, people taking the maintenance dose of the medication actually lost an average of 2 pounds over 3 months. Talk to your prescriber if you're worried about any changes in your weight while you're taking Savella (milnacipran).
No. Savella (milnacipran) tablets aren't designed to be cut. There are many different tablet strengths available: 12.5 mg, 25 mg, 50 mg, and 100 mg. Talk to your prescriber if you think you need to change your dose. They can see if your prescription needs to be adjusted.
In clinical studies, some people reported that their pain was "much" or "very much" improved after just a week of taking Savella (milnacipran) at a stable dose. But it can take up to a few months for others to feel the full effects. Talk to your prescriber if you don't notice any relief from fibromyalgia pain after several weeks to months of taking the medication.
Talk to your prescriber or obstetrician-gynecologist (OB-GYN) about the risks and benefits of taking Savella (milnacipran) during pregnancy. It's not clear if it's safe to take while pregnant. But in some cases, people had more bleeding after childbirth when they took Savella (milnacipran) in the third trimester. Some newborns also had breathing or feeding problems. If you took the medication during pregnancy, you can join the Savella Pregnancy Registry. It helps researchers learn how the medication affects pregnancy and the baby's health after birth.
Savella (milnacipran) and duloxetine (Cymbalta) are both FDA-approved medications for treating fibromyalgia. But they have some key differences. Savella (milnacipran) is only for adults. But duloxetine (Cymbalta) is for people 13 years and older with fibromyalgia. Also, Savella (milnacipran) is taken twice a day while duloxetine (Cymbalta) is taken once a day. Duloxetine (Cymbalta) is also FDA approved for depression, anxiety, and certain other types of chronic pain. Talk to your prescriber about comparing the medications.
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Risks and warnings for Savella (milnacipran)
Savella (milnacipran) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Suicidal thoughts and behavior
- Risk factors: Age under 24 years old | History of depression or suicidal behavior
Savella (milnacipran) is similar to some antidepressants that can raise the risk of worsening depression and suicidal thoughts or behavior. The risk is higher in people younger than 24 and people with depression. Talk to your prescriber if you're worried about this risk.
Watch for new or worsening signs of depression or suicidal thoughts or behavior. Be on the lookout especially when the dose of Savella (milnacipran) changes and during the first few months of treatment. Tell your prescriber if you or your loved ones notice any unusual changes in your mood or behavior while you're taking this medication. Call 911 if you have suicidal thoughts or behavior.
Serotonin syndrome
- Risk factors: Taking other medications that can raise serotonin in the brain
Although rare, Savella (milnacipran) can cause serotonin syndrome. This is a serious condition caused by too much serotonin in the brain. The risk is higher if you're taking another medication that affects serotonin levels. Examples include certain antidepressants, opioid medications, and triptans. It's important to tell your prescriber and pharmacist about all the medications you take so they can check your risk for serotonin syndrome.
Symptoms of serotonin syndrome include fever, sweating, movement problems, distress, and hallucinations. Stop taking Savella (milnacipran) and get emergency medical help right away if you have any of these symptoms.
Higher blood pressure and faster heart rate
- Risk factors: History of high blood pressure | History of problems with heart rate
Some people taking Savella (milnacipran) have had higher blood pressure or a faster heart rate than usual. If you have high blood pressure or take medication to control your heart rate, talk to your prescriber before starting Savella (milnacipran). They can check if it's safe for you.
Let your care team know if your blood pressure or heart rate stays high during treatment. You might need a lower dose of Savella (milnacipran) or might have to stop taking the medication.
Higher risk of bleeding
- Risk factors: Taking other medications that can make bleeding more likely (e.g., blood thinners, NSAIDs)
Savella (milnacipran) can raise your risk of bleeding or bruising. The risk is even higher if you also take blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin). These medications can also make bleeding more likely.
Bleeding and bruising can be mild, like with nosebleeds, or more serious. Tell your prescriber if you have unusual bleeding or bruising or if it doesn't go away while taking Savella (milnacipran).
Urination problems
- Risk factors: Swollen or enlarged prostate | Inflamed prostate | History of other urinary problems
Some people taking Savella (milnacipran) have had issues with urination. This can include having pain when urinating or having trouble urinating. Let your prescriber know if you've had pain while urinating before, especially if you have an enlarged prostate or other urinary problems. Tell your prescriber if you notice any changes in urination while you're taking this medication.
Sexual problems
Savella (milnacipran) can cause sexual problems as a side effect. They can include a lower sex drive, trouble getting or keeping an erection, problems ejaculating, and trouble having an orgasm. Tell your prescriber if you notice any changes in your sex life and when they started. They can check if something else is causing the problem and help you find ways to manage this side effect.
Liver damage
- Risk factors: Chronic liver problems | Long-term or heavy drinking
Some people taking Savella (milnacipran) might have higher liver enzyme levels, which can be a sign of liver damage. Savella (milnacipran) is usually not recommended for people with a chronic liver condition. It's also not recommended for people who drink heavily since alcohol can already cause liver damage.
Tell your prescriber right away if you notice yellowing of your skin or eyes, pain in your upper stomach, or dark urine while taking Savella (milnacipran). These can be signs of liver damage. You might have to switch to a different medication.
Worsening of glaucoma in certain people
Savella (milnacipran) can make glaucoma worse in some people. Tell your prescriber if you have narrow-angle eyes or angle-closure glaucoma and haven't had laser surgery. Call your eye specialist right away if you have sudden blurry vision, severe eye pain, headache, see halos around lights, or feel nauseous. These could be signs of an angle-closure attack that needs urgent care.
Savella (milnacipran) dosage
Typical dosage for Savella (milnacipran)
You'll usually start at a low dose of Savella (milnacipran). Then, your prescriber will raise your dose over a span of a week until you reach a maintenance dose.
- Day 1: Take 12.5 mg by mouth once daily.
- Days 2 to 3: Take 12.5 mg by mouth twice daily.
- Days 4 to 7: Take 25 mg by mouth twice daily.
- After Day 7 (maintenance dose): Take 50 mg by mouth twice daily.
If you need more pain relief, your prescriber might raise your maintenance dose to 100 mg twice daily.
Your maintenance dose might be different if you have severe kidney problems.
Interactions between Savella (milnacipran) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Furazolidone
- Iproniazid
- Isocarboxazid
- Linezolid
- Methylene Blue
- Metoclopramide
- Moclobemide
- Phenelzine
- Procarbazine
- Rasagiline
- Safinamide
- Selegiline
- Tranylcypromine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abciximab
- Aceclofenac
- Acemetacin
- Acenocoumarol
- Alfentanil
- Almotriptan
- Amifampridine
- Amitriptyline
- Amoxapine
- Amphetamine
- Amtolmetin Guacil
- Anagrelide
- Ancrod
- Anisindione
- Antithrombin III Human
- Apixaban
- Aripiprazole
- Aspirin
- Avitriptan
- Bemiparin
- Benperidol
- Benzhydrocodone
- Benzphetamine
- Bivalirudin
- Bromfenac
- Bufexamac
- Buprenorphine
- Bupropion
- Butorphanol
- Celecoxib
- Chlorpromazine
- Choline Salicylate
- Cilostazol
- Citalopram
- Clonixin
- Clopidogrel
- Clovoxamine
- Clozapine
- Codeine
- Cyclobenzaprine
- Danaparoid
- Defibrotide
- Dermatan Sulfate
- Desirudin
- Desvenlafaxine
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Dextromethorphan
- Diclofenac
- Dicumarol
- Diflunisal
- Dihydrocodeine
- Dipyridamole
- Dipyrone
- Dolasetron
- Donepezil
- Droxicam
- Duloxetine
- Edoxaban
- Eletriptan
- Epoprostenol
- Eptifibatide
- Escitalopram
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Femoxetine
- Fenfluramine
- Fenoprofen
- Fentanyl
- Fepradinol
- Feprazone
- Floctafenine
- Fluconazole
- Flufenamic Acid
- Fluoxetine
- Fluphenazine
- Flurbiprofen
- Fluvoxamine
- Fondaparinux
- Frovatriptan
- Granisetron
- Haloperidol
- Heparin
- Hydrocodone
- Hydromorphone
- Ibuprofen
- Iloprost
- Indomethacin
- Iobenguane I 123
- Iobenguane I 131
- Ketoprofen
- Ketorolac
- Lamifiban
- Lasmiditan
- Levomilnacipran
- Levorphanol
- Lexipafant
- Lisdexamfetamine
- Lithium
- Lorcaserin
- Lornoxicam
- Loxapine
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Meperidine
- Mesoridazine
- Metaxalone
- Methadone
- Methamphetamine
- Mirtazapine
- Molindone
- Morniflumate
- Morphine
- Morphine Sulfate Liposome
- Nabumetone
- Nadroparin
- Nalbuphine
- Naproxen
- Naratriptan
- Nefazodone
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Olanzapine
- Ondansetron
- Oxaprozin
- Oxycodone
- Oxymorphone
- Oxyphenbutazone
- Ozanimod
- Palonosetron
- Parecoxib
- Paroxetine
- Pentazocine
- Pentosan Polysulfate Sodium
- Perphenazine
- Phenindione
- Phenprocoumon
- Phenylbutazone
- Piketoprofen
- Pimozide
- Piroxicam
- Pranoprofen
- Proglumetacin
- Promazine
- Propyphenazone
- Proquazone
- Quetiapine
- Remifentanil
- Risperidone
- Rivaroxaban
- Rizatriptan
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sertraline
- Sibrafiban
- Sibutramine
- Sodium Salicylate
- Sufentanil
- Sulfinpyrazone
- Sulindac
- Sulodexide
- Sumatriptan
- Tapentadol
- Tenoxicam
- Thioridazine
- Thiothixene
- Tiaprofenic Acid
- Ticlopidine
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Tramadol
- Trazodone
- Trifluoperazine
- Tryptophan
- Valdecoxib
- Venlafaxine
- Vilazodone
- Vortioxetine
- Warfarin
- Xemilofiban
- Zimeldine
- Ziprasidone
- Zolmitriptan
How much does Savella (milnacipran) cost?
$456.65
Savella (milnacipran) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Savella (milnacipran) will not be safe for you to take.
- Take a monoamine oxidase inhibitor (MAOI) currently or within the last 14 days
What are alternatives to Savella (milnacipran)?
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