- With Mayo Clinic internal medicine specialist
Ann Vincent, M.D.
Causes (1)
- Is fibromyalgia hereditary?
Complications (1)
- Fibromyalgia: Can it cause elevated ESR and CRP levels?
Treatments and drugs (3)
- Milnacipran (Savella) for fibromyalgia: What makes it different?
- Fibromyalgia treatment: Does gabapentin relieve symptoms?
- TENS therapy: An option for fibromyalgia treatment?
Alternative medicine (1)
- Cupping therapy: Can it relieve fibromyalgia pain?
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Question
Milnacipran (Savella) for fibromyalgia: What makes it different?
How is milnacipran, the new fibromyalgia drug, different from other fibromyalgia medications?
Answer
from Ann Vincent, M.D.
Milnacipran, marketed under the brand name Savella in the United States, is the latest drug to receive Food and Drug Administration (FDA) approval for the management of fibromyalgia. The FDA approved fibromyalgia indications for two other drugs — pregabalin (Lyrica) and duloxetine (Cymbalta) — in 2007 and 2008, respectively.
In clinical trials, milnacipran was significantly better than was placebo at reducing pain and other physical symptoms in study participants who had fibromyalgia and did not also have depression or anxiety.
Outside the United States, milnacipran already has a track record as an antidepressant. It is similar to duloxetine (Cymbalta), in that both drugs increase the supply of serotonin and norepinephrine (chemical messengers, also known as neurotransmitters) available to your brain. The difference is that milnacipran gives your brain a larger boost in norepinephrine. Neuroscientists refer to this property of milnacipran as "norepinephrine selectivity."
Many studies have demonstrated that pain receptors tend to be hypersensitive in people with fibromyalgia. By exerting a stronger effect on norepinephrine than on serotonin, milnacipran may scale back the brain's exaggerated reaction to neurochemicals associated with painful sensations.
If your doctor prescribes milnacipran for your fibromyalgia symptoms, you'll typically start with a low dose. Then, under your doctor's guidance, you can gradually work up to 100 milligrams (mg) a day, usually in two separate 50 mg doses. The dose can go up to 200 mg a day if your symptoms don't improve.
Next questionFibromyalgia treatment: Does gabapentin relieve symptoms?
- Savella (prescribing information). New York, N.Y.: Forest Pharmaceuticals, Inc.; 2009. http://www.frx.com/pi/Savella_pi.pdf. Accessed July 16, 2009.
- Kroenke K, et al. Pharmacotherapy of chronic pain: A synthesis of recommendations from systematic reviews. General Hospital Psychiatry. 2009;31:206.
- Mease PJ, et al. The efficacy and safety of milnacipran for treatment of fibromyalgia. A randomized, double-blind, placebo-controlled trial. The Journal of Rheumatology. 2009;36:398.
