Neocipran

Indications

Milnacipran Hydrochloride is used to manage fibromyalgia, a long-term condition causing widespread muscle pain, tiredness and poor sleep. In some countries it is also used to treat depression (major depressive disorder) in adults.

How It Works

Milnacipran is a serotonin and noradrenaline reuptake inhibitor (SNRI). It increases the levels of two natural brain chemicals, serotonin and noradrenaline, by stopping nerve cells from taking them back up. These chemicals help control mood and also dampen pain signals travelling through the spinal cord, which can reduce pain in fibromyalgia.

Dosage and Administration

Take exactly as prescribed. Treatment starts with a low dose that is increased step by step over about a week to reduce side effects such as nausea; the usual maintenance dose is divided into two doses a day. Take with food to reduce stomach upset. A lower dose is needed in kidney disease. Do not stop suddenly; your doctor will reduce the dose gradually.

Interactions

Do not take with MAO inhibitors (including Linezolid and Methylene blue) or within 14 days of stopping one, and allow 5 days after stopping Milnacipran before starting an MAO inhibitor. Other serotonin medicines (SSRIs, other SNRIs, Tramadol, Triptans, Lithium, St John's Wort) raise the risk of serotonin syndrome. Aspirin, NSAIDs, Warfarin and Clopidogrel increase bleeding risk. Clonidine effects may be reduced. Digoxin given by injection may cause blood pressure and heart rhythm changes. Adrenaline and Noradrenaline may cause high blood pressure.

Contraindications

Do not use if you are allergic to Milnacipran, are taking or recently took an MAO inhibitor, or have uncontrolled narrow-angle glaucoma. Not for children.

Side Effects

Common side effects include nausea, headache, constipation, dizziness, trouble sleeping, hot flushes, sweating, fast heartbeat, raised blood pressure, dry mouth, vomiting and difficulty passing urine. Men may have testicular pain or ejaculation problems.

Get urgent medical help if you have thoughts of suicide or self-harm, agitation, hallucinations, high fever, muscle stiffness, fast heartbeat and confusion (possible serotonin syndrome), very high blood pressure with severe headache, unusual bleeding, fits, yellowing of the skin or eyes, or sudden eye pain with vision changes.

Pregnancy and Lactation

Use in pregnancy only if the doctor decides the benefit outweighs the risk; use late in pregnancy may cause problems in the newborn and increase bleeding after delivery. It may pass into breast milk; ask your doctor before breastfeeding.

Precautions and Warnings

Young adults under 25 may have an increased risk of suicidal thoughts when starting treatment or changing the dose; family members should watch for mood changes. Blood pressure and heart rate should be checked regularly. Tell your doctor about heart disease, high blood pressure, seizures, bipolar disorder, liver or kidney disease, glaucoma, urinary problems or heavy alcohol use. It may cause low sodium, especially in older people.

Overdose

Overdose may cause vomiting, high blood pressure, fast heartbeat, drowsiness, fits and serotonin syndrome. Seek emergency medical help immediately.

Therapeutic Class

Serotonin and noradrenaline reuptake inhibitor (SNRI).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.