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Savella
milnacipran
Black Box Warnings .
Suicidality
milnacipran is an SNRI, similar to drugs used for tx of depression and other psychiatric disorders; incr. suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders; weigh risk vs. benefit; in short-term studies of antidepressants vs. placebo, suicidality risk not incr. in pts >24 yo, and risk decr. in pts 65 yo and older; depression and certain other psychiatric disorders themselves assoc. w/ incr. suicide risk; observe all pts for clinical worsening, suicidality, or unusual behavior changes; advise families and caregivers of need for close observation and communication w/ prescriber; not approved for peds use or tx of major depressive disorders
Adult Dosing .
Dosage forms: TAB: 12.5 mg, 25 mg, 50 mg, 100 mg; convenience pack
Special Note
- [convenience pack components]
- Info: 4-wk titration pack contains 12.5 mg tab x5 and 25 mg tab x8 and 50 mg tab x42
fibromyalgia
- [50 mg PO bid]
- Start: 12.5 mg PO qd x1 day, then 12.5 mg PO bid x2 days, then 25 mg PO bid x4 days, then 50 mg PO bid; Max: 200 mg/day; Info: taper dose gradually to D/C
renal dosing
- [see below]
- CrCl > 50: no adjustment; CrCl 30-49: not defined, caution advised; CrCl 5-29: decr. usual maint. dose by 50%, max 100 mg/day; ESRD: avoid use
- HD/PD: not defined
hepatic dosing
- [see below]
- Child-Pugh Class A or B: no adjustment; Child-Pugh Class C: not defined, caution advised; chronic hepatic dz: avoid use
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.