Savella is a brand-name medicine that contains milnacipran. It belongs to a group of medicines called serotonin-norepinephrine reuptake inhibitors, or SNRIs, which affect chemicals in the brain and nervous system that are involved in pain signals.
In the United States, Savella is approved by the FDA only for the management of fibromyalgia in adults. It is not approved in the US to treat depression, although milnacipran may be used differently in some other countries.
Fibromyalgia is a long-term condition that can cause widespread pain, tiredness, poor sleep, and problems with daily function. Savella may help reduce pain and improve how some people feel overall, but its benefits can vary from person to person.
Indications for use
Savella is indicated for the management of fibromyalgia in adults.
It is used to help manage symptoms linked to fibromyalgia, especially widespread pain. Evidence from clinical trials and reviews suggests that milnacipran can help some adults achieve meaningful pain relief, although not everyone responds to treatment.
Savella is not FDA-approved in the United States for children or for treating depression.
How it works
Savella works as an SNRI, which means it affects serotonin and norepinephrine activity in the nervous system. These chemical messengers are involved in how pain signals are processed.
By changing the activity of these messengers, Savella may help reduce pain sensitivity in some people with fibromyalgia. It does not cure fibromyalgia, and it is usually considered part of a broader treatment plan.
How to take it
Savella is taken by mouth as a tablet. It can be taken with or without food, although taking it with food may help reduce nausea.
The usual target dose is 50 mg twice per day, for a total of 100 mg per day. Treatment is usually started at a lower dose and increased gradually over about 1 week to help the body adjust.
The maximum recommended dose is 100 mg twice per day, for a total of 200 mg per day. A lower dose may be needed for people with kidney problems.
Savella tablets may be available in strengths such as 12.5 mg, 25 mg, 50 mg, and 100 mg. The exact dose, schedule, and duration of treatment should be defined by a doctor based on symptoms, response to treatment, side effects, and kidney function.
Treatment should not be stopped suddenly unless a doctor recommends it. Stopping Savella too quickly can cause withdrawal-like symptoms, so the dose is usually reduced slowly when treatment needs to end.
How long it takes to work
Savella may take several weeks to show its full effect. Some clinical guidance suggests reassessing treatment if there is no clear benefit after a reasonable trial period, such as around 12 weeks.
If symptoms do not improve or side effects are difficult to tolerate, a doctor may adjust the dose or consider another treatment option.
Possible side effects
The most common side effects of Savella are digestive symptoms, such as nausea, vomiting, constipation, dry mouth, and stomach discomfort.
Other possible side effects include dizziness, headache, trouble sleeping, increased sweating, hot flashes, palpitations, increased heart rate, or increased blood pressure. Some people may also have urinary symptoms or sexual side effects.
More serious side effects are less common, but may include a significant increase in blood pressure or heart rate, serotonin syndrome, unusual bleeding, low sodium levels, severe allergic reactions, worsening mood, or suicidal thoughts.
Serotonin syndrome is a rare but serious reaction that can happen when medicines that affect serotonin are combined. Symptoms may include agitation, confusion, fast heartbeat, fever, sweating, tremors, muscle stiffness, nausea, vomiting, or diarrhea.
Contraindications
Savella should not be used with monoamine oxidase inhibitors, also called MAOIs, or within a recent period of using one. Combining these medicines can increase the risk of serious reactions, including serotonin syndrome.
Savella is also contraindicated in people with uncontrolled narrow-angle glaucoma.
This medicine may not be appropriate for some people with uncontrolled high blood pressure, certain heart problems, liver or kidney disease, a history of bleeding problems, low sodium levels, seizures, or bipolar disorder. These are not always absolute contraindications, but they require careful medical review before treatment.
Precautions for use
Blood pressure and heart rate may need to be checked before and during treatment with Savella. This is because milnacipran can raise blood pressure and increase heart rate in some people.
Savella may also increase the risk of bleeding, especially when used with medicines that affect clotting. These can include aspirin, nonsteroidal anti-inflammatory drugs, anticoagulants, and some other antidepressants.
Pregnancy and breastfeeding require individualized medical guidance. The attached sources note pregnancy and lactation considerations, but treatment decisions depend on the expected benefits and possible risks.