Milnacipran is used to treat chronic pain caused by fibromyalgia (a medical condition that causes chronic pain in the muscles and joints).

Milnacipran may also be used for purposes not listed in this medication guide.

You should not use milnacipran if you are allergic to it.

Do not use milnacipran if you have used an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine. After you stop taking milnacipran, you must wait at least 5 days before you start taking an MAOI.

Milnacipran should not be given to a child younger than 18 years old.

Tell your doctor if you have ever had:

• liver disease;
• kidney disease;
• heart disease, high blood pressure;
• seizures or epilepsy;
• bipolar disorder (manic depression);
• bleeding problems;
• low levels of sodium in your blood;
• sexual problems;
• if you drink alcohol; or
• if you take a blood thinner such as warfarin (Coumadin, Jantoven).

Be sure your doctor knows if you also take stimulant medicine, opioid medicine, herbal products, or medicine for depression, mental illness, Parkinson's disease, migraine headaches, serious infections, or prevention of nausea and vomiting. These medicines may interact with milnacipran and cause a serious condition called serotonin syndrome.

Some young people have thoughts about suicide when first taking milnacipran. Your doctor should check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Taking this medicine during pregnancy may cause serious lung problems or other complications in the baby. Tell your doctor right away if you become pregnant. Do not start or stop taking this medicine during pregnancy without your doctor's advice.

If you are pregnant, your name may be listed on a pregnancy registry to track the effects of milnacipran on the baby.

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.

Use Savella Titration Pack (Oral) exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

• little or no urination;
• blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• a seizure;
• a light-headed feeling, like you might pass out;
• liver problems--stomach pain (upper right side), itching, dark urine, jaundice (yellowing of the skin or eyes);
• low sodium level--headache, confusion, severe weakness, vomiting, problems with thinking or memory, feeling unsteady; or
• manic episodes--racing thoughts, increased energy, unusual risk-taking behavior, extreme happiness, being irritable or talkative.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Some side effects may be more likely in older adults.

Common side effects may include:

• nausea, vomiting, constipation;
• dry mouth;
• increased blood pressure;
• fast or pounding heartbeats;
• increased sweating, flushing (warmth, redness, or tingly feeling);
• headache, dizziness; or
• trouble sleeping.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Avoid drinking alcohol.

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac, indomethacin, meloxicam, and others. Using an NSAID with milnacipran may cause you to bruise or bleed easily.