TaperCommunitymilnacipran
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
Milnacipran is a serotonin-norepinephrine reuptake inhibitor (SNRI) approved in the US for fibromyalgia management. It has a roughly 3:1 selectivity for norepinephrine over serotonin reuptake inhibition.
12.5mg, 25mg, 50mg, 100mg
Tablets: 12.5mg, 25mg, 50mg, 100mg; Titration pack: 12.5mg and 25mg tablets
Category C (risk cannot be ruled out)
Dual reuptake inhibitor of serotonin and norepinephrine with preferential activity at the norepinephrine transporter (NET > SERT, approximately 3:1 ratio).
SNRI approved for fibromyalgia (not depression in the US). Short half-life requires twice-daily dosing. Taper gradually — abrupt discontinuation causes withdrawal syndrome.
Reduce dose gradually over at least 1–2 weeks. Consider smaller dose reductions at lower doses. Short half-life means symptoms can emerge within 24 hours of missed dose.
Toxicity
Serotonin syndrome risk. Hypertension and tachycardia. Hepatotoxicity reported rarely.
Savella (milnacipran) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Neutral, high-authority entity references.
Primary literature cited in this taper guide.
Evidence-based deprescribing and prescribing standards.
Clinician-facing references on tapering protocols.
Long-running communities documenting withdrawal experience.
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.
Pharmacokinetics
Well absorbed (85–90% bioavailability). Tmax ~2–4 hours. Food does not affect AUC but delays Tmax.
~400 L
Hepatic — primarily conjugation (glucuronidation), not significantly CYP-mediated. Active desethyl metabolite.
Renal (55% unchanged, 24% as glucuronide conjugate).
13%
~60 L/hr
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