It is important that your doctor check your progress at regular visits to allow for changes in your dose and to help reduce any side effects.
It is important to tell your doctor if you become pregnant. Your doctor may want you to join a pregnancy registry for patients taking this medicine.
Milnacipran may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you or your caregiver notice any of these side effects, tell your doctor right away.
Do not take this medicine during the 2 weeks (14 days) after stopping a monoamine oxidase inhibitor (MAOI) (e.g., isocarboxazid [Marplan®], phenelzine [Nardil®], selegiline [Eldepryl®], or tranylcypromine [Parnate®]). Do not take an MAO inhibitor for at least 5 days after stopping milnacipran. If you do, you may have serious side effects such as seizures. Talk to your doctor about this if you have questions.
Make sure your doctor knows if you are also using aspirin, NSAIDs (e.g., ibuprofen, naproxen, Advil®, Aleve®, Celebrex®, or Motrin®), or a blood thinner (e.g., warfarin or Coumadin®). Milnacipran may increase your risk of bleeding problems when taken together with these medicines.
Make sure your doctor knows about all the other medicines you are using. This medicine may cause a serious condition called serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions when taken with certain medicines such as lithium, tryptophan, or some pain or migraine medicines (e.g., rizatriptan [Maxalt®], sumatriptan [Imitrex®], tramadol [Ultram®], or zolmitriptan [Zomig®]. Check with your doctor first before taking any other medicines.
You will also need to have your blood pressure and pulse measured before starting and while you are using this medicine. If you notice any change to your recommended blood pressure or pulse rate, call your doctor right away. If you have questions about this, talk to your doctor.
Liver problems may occur while you are using this medicine. Stop using this medicine and check with your doctor right away if you are having more than one of these symptoms: abdominal pain or tenderness; clay-colored stools; dark urine; decreased appetite; fever; headache; itching; loss of appetite; nausea and vomiting; skin rash; swelling of the feet or lower legs; unusual tiredness or weakness; or yellow eyes or skin.
Avoid taking alcohol while you are using this medicine.
This medicine may cause some people to become less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert.
Do not suddenly stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely to decrease the chance of side effects.