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Savella
Savella (generic name: milnacipran) is a medication used to treat fibromyalgia, a chronic condition characterized by widespread pain, fatigue, and tenderness. It belongs to a class of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs). Savella works by increasing the levels of the neurotransmitters serotonin and norepinephrine in the brain, which helps reduce pain signals and improve mood. While it is not an antidepressant, Savella is specifically approved to manage the pain and other symptoms associated with fibromyalgia.
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Frequently Asked Questions
How long does it take for Savella to start working?
Some patients may begin to feel relief from symptoms within 1 to 2 weeks, but it may take several weeks (up to 4-6 weeks) to experience the full benefits of the medication.
Can I take Savella with other antidepressants?
Caution is advised when taking Savella with other antidepressants, particularly SSRIs, SNRIs, or MAOIs, as these combinations can increase the risk of serotonin syndrome. Always consult your healthcare provider before combining medications.
What should I do if I miss a dose of Savella?
If you miss a dose, take it as soon as you remember. If it’s close to the time for your next dose, skip the missed dose and continue your regular schedule. Do not double the dose.
Can Savella cause weight gain?
Savella is not typically associated with weight gain; however, changes in appetite may occur in some individuals. If you experience significant weight changes, inform your healthcare provider.
Is Savella safe for long-term use?
Yes, Savella can be used long-term to manage fibromyalgia, but regular monitoring by your healthcare provider is essential to ensure that the medication remains safe and effective for your condition.
Comprehensive Drug Guide
How Does Savella Work?
Savella works by inhibiting the reuptake of the neurotransmitters serotonin and norepinephrine, which are involved in pain regulation and mood. By increasing the levels of these neurotransmitters in the brain, Savella helps reduce the intensity of pain signals sent through the nervous system. This mechanism helps relieve the pain and discomfort associated with fibromyalgia while also improving fatigue and other symptoms.
Common Dosages
- 12.5 mg, 25 mg, 50 mg, and 100 mg tablets.
Typical Dosing
- Day 1: Start with 12.5 mg once daily.
- Days 2-3: Increase to 12.5 mg twice daily.
- Days 4-7: Increase to 25 mg twice daily.
- After Day 7, the recommended maintenance dose is 50 mg twice daily.
- The dose can be increased up to 100 mg twice daily if needed, based on patient response and tolerability.
Savella should be taken with or without food, and the dose may be adjusted for patients with kidney impairment.
Typical Dosing
FDA Approved Indications
- Management of fibromyalgia in adults.
Who Shouldn't Take Savella?
- Uncontrolled narrow-angle glaucoma.
- Use of monoamine oxidase inhibitors (MAOIs): Savella should not be taken within 14 days of using an MAOI, as this could lead to serious drug interactions.
- Known hypersensitivity to milnacipran or any component of the formulation.
Advice From The Pharmacist
- Take Savella exactly as prescribed. Do not skip doses or stop taking the medication abruptly, as this can lead to withdrawal symptoms.
- Gradually increase the dose as directed by your healthcare provider to minimize the risk of side effects such as nausea and dizziness.
- If you experience side effects like nausea, take Savella with food to help reduce stomach upset.
- Do not stop taking Savella suddenly. If discontinuation is necessary, your healthcare provider will likely taper the dose slowly to avoid withdrawal symptoms such as dizziness, irritability, or insomnia.
- Monitor for changes in mood or behavior, especially during the first few weeks of treatment, as Savella may increase the risk of suicidal thoughts in some individuals, particularly younger patients.
Side Effects of Savella
Common Side Effects
- Nausea
- Dizziness
- Headache
- Constipation
- Increased sweating
- Insomnia
- Hot flashes
Uncommon/Severe Side Effects
- Increased blood pressure or heart rate: Savella can increase heart rate and blood pressure in some individuals, particularly at higher doses.
- Serotonin syndrome: A potentially life-threatening condition caused by too much serotonin in the brain. Symptoms include agitation, hallucinations, rapid heart rate, fever, and muscle rigidity.
- Liver problems: Symptoms include dark urine, yellowing of the skin or eyes (jaundice), or severe stomach pain.
Risks and Warnings of Savella
- Serotonin syndrome: Combining Savella with other drugs that increase serotonin levels (e.g., SSRIs, SNRIs, triptans, or MAOIs) can increase the risk of serotonin syndrome, a potentially life-threatening condition.
- Blood pressure and heart rate: Savella can increase blood pressure and heart rate, particularly in individuals with pre-existing cardiovascular conditions. Blood pressure and pulse should be monitored regularly during treatment.
- Suicidal thoughts: Like other SNRIs, Savella may increase the risk of suicidal thoughts and behavior, especially in younger individuals. Patients should be monitored for changes in mood or behavior, particularly during the first few months of treatment.
- Withdrawal symptoms: Abruptly discontinuing Savella can lead to withdrawal symptoms such as dizziness, irritability, or flu-like symptoms. Always follow your healthcare provider’s advice when stopping the medication.
Interactions with Savella
Common Drug Interactions
- MAO inhibitors: Savella should not be used with MAOIs (e.g., phenelzine, selegiline) due to the risk of serotonin syndrome.
- Other serotonergic drugs: Combining Savella with other medications that increase serotonin levels (e.g., SSRIs, SNRIs, triptans) can increase the risk of serotonin syndrome.
- Blood pressure medications: Savella can increase blood pressure and heart rate, so caution is advised when combining it with antihypertensive medications.
- Tricyclic antidepressants (TCAs): Combining Savella with TCAs may increase the risk of side effects such as serotonin syndrome or high blood pressure.
Alternatives to Savella
- Lyrica (pregabalin): A medication used to treat fibromyalgia by reducing pain signals in the brain.
- Cymbalta (duloxetine): Another SNRI approved for fibromyalgia, depression, and anxiety.
- Gabapentin: An anticonvulsant medication often used to treat nerve pain and fibromyalgia.
- Amitriptyline: A tricyclic antidepressant used off-label to manage fibromyalgia symptoms, particularly pain and sleep disturbances.
