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The safety and warning information for Savella (milnacipran) is crucial for ensuring safe use of the medication. Please review the following points carefully and consult your healthcare provider if you have any concerns:

• Suicidal Thoughts and Behavior: Similar to certain antidepressants, Savella can increase the risk of worsening depression and suicidal thoughts or behavior, particularly in individuals younger than 24 or those with a history of depression. It is important to discuss these risks with your healthcare provider, especially if you are concerned about these potential effects.

• Serotonin Syndrome: Though uncommon, Savella might lead to serotonin syndrome, a potentially severe condition caused by excess serotonin in the brain. The risk is heightened if you are concurrently using other medications that affect serotonin levels, such as specific antidepressants, opioid medications, or triptans. Always inform your healthcare provider and pharmacist of all medications you are taking to assess your risk for serotonin syndrome.

• Increased Blood Pressure and Heart Rate: Some individuals may experience elevated blood pressure or an accelerated heart rate while on Savella. If you have a history of high blood pressure or heart rate issues, consult your healthcare provider before starting this medication to ensure it is safe for you.

• Increased Bleeding Risk: Savella can elevate the risk of bleeding or bruising, especially if taken with blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Inform your healthcare provider if you are taking medications that may increase bleeding risk.

• Urination Issues: Some patients on Savella report difficulties with urination, such as pain or trouble urinating. If you have a history of urinary issues, especially related to a swollen prostate, discuss these with your healthcare provider and report any new changes in urination promptly.

• Sexual Dysfunction: Sexual side effects like reduced libido, difficulty achieving or maintaining an erection, ejaculation problems, or trouble reaching orgasm can occur. Notify your healthcare provider if you experience any changes in your sexual health to explore management options.

• Liver Damage: Elevated liver enzyme levels, indicating potential liver damage, have been observed in some patients on Savella. Individuals with chronic liver conditions or those who consume alcohol heavily should avoid this medication. Discuss your liver health with your healthcare provider to determine your suitability for this treatment.

• Glaucoma Worsening: Savella may exacerbate glaucoma symptoms. If you have narrow-angle eyes or angle-closure glaucoma without having had laser surgery, be vigilant of symptoms like sudden blurred vision, severe eye pain, headaches, seeing halos, or nausea, and seek immediate care if they occur.

Contraindications:

• Do not use Savella if you are currently taking or have recently (within the last 14 days) taken a monoamine oxidase inhibitor (MAOI), due to potential serious health risks.

Always ensure you discuss your full medical history and any current medications with your healthcare provider to safely manage your treatment with Savella.

When taking this medication, some individuals might experience mild side effects such as nausea, headache, constipation, trouble sleeping, hot flashes, and dizziness. These effects are generally not severe, but if they persist or worsen, it is advisable to consult a healthcare provider. Additionally, some users report vomiting, dry mouth, excessive sweating, migraines, and upper respiratory infections.

Be aware that this medication can also cause an increase in blood pressure or a racing heart rate. It may impact sexual function, potentially leading to a decreased interest in sex or difficulties with sexual performance. If any of these occur, contacting a healthcare professional is recommended.

There are also more serious side effects that, although rare, require immediate medical attention. These include suicidal thoughts, serotonin syndrome characterized by symptoms like fever and hallucinations, liver damage indicated by jaundice or dark urine, and low sodium levels leading to confusion or seizures. Unusual bleeding or bruising, severe allergic reactions like rash or trouble breathing, and seizures also demand urgent care.

It's important to be vigilant about these potential side effects and seek medical help if severe symptoms arise. Always inform your healthcare provider of all medications you're taking to avoid interactions that might increase the risk of serious conditions.

When taking Savella (milnacipran), it's important to be aware of potential interactions with other medications. This drug should not be used with MAO inhibitors like isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, or tranylcypromine as these combinations can lead to a dangerous and potentially fatal interaction. It's recommended to avoid MAO inhibitors while on Savella and for two weeks before and at least five days after using it. Consult your doctor about when to safely start or stop these medications.

Additionally, certain drugs that increase the risk of bleeding or bruising, such as antiplatelet agents like clopidogrel, NSAIDs like ibuprofen or naproxen, and anticoagulants like dabigatran or warfarin, may have interactions with Savella. If you're advised by your doctor to take low-dose aspirin (81-162 mg daily) for heart attack or stroke prevention, continue only if instructed.

Savella may also elevate the risk of serotonin syndrome, especially if taken with other serotonin-enhancing drugs like street drugs (e.g., MDMA), St. John's wort, specific antidepressants (like SSRIs such as fluoxetine or paroxetine, and SNRIs like duloxetine or venlafaxine), and tryptophan. This risk is heightened when starting or increasing doses of these medications.

Lastly, avoid using levomilnacipran while on milnacipran, as they are very similar. Always inform your healthcare provider about all medications and supplements you are taking to manage these interactions effectively.