Reprints
A single copy of this article may be reprinted for personal, noncommercial use only.
Milnacipran (Savella) for fibromyalgia: What makes it different?
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/milnacipran/AN02019
- With Mayo Clinic internal medicine specialist
Ann Vincent, M.D.
Causes (1)
- Is fibromyalgia hereditary?
Complications (1)
- Fibromyalgia: Can acupuncture relieve symptoms?
Treatments and drugs (3)
- Fibromyalgia treatment: Is Neurontin effective?
- TENS therapy: An option for fibromyalgia treatment?
- Milnacipran (Savella) for fibromyalgia: What makes it different?
Alternative medicine (2)
- Cupping therapy: Can it relieve fibromyalgia pain?
- What is hot yoga?
Free
E-newsletter
Subscribe to Housecall
Our weekly general interest
e-newsletter keeps you up to date
on a wide variety of health topics.
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
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.
Outside the United States, milnacipran already has a track record as an antidepressant.
It is similar to duloxetine 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.
In clinical trials, milnacipran was significantly better than was a placebo at reducing pain and other physical symptoms in study participants who had fibromyalgia and did not also have depression or anxiety.
Studies are under way to determine whether milnacipran may also improve sleep disturbances common to fibromyalgia. Upcoming clinical trials may determine whether milnacipran can be safely and effectively given in combination with other fibromyalgia medications.
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. In some cases, the dose can be increased to 200 mg a day.
Next questionCupping therapy: Can it relieve fibromyalgia pain?
- Mease PJ, et al. Pharmacotherapy of fibromyalgia. Rheumatic Disease Clinics of North America. 2009;35:359.
- Arnold LM. The pathophysiology, diagnosis and treatment of fibromyalgia. Psychiatric Clinics of North America. 2010;33:375.
- Goldenberg DL. Treatment of fibromyalgia in adults. http://www.uptodate.com/home/index.html. Accessed July 29, 2011.
- The effects of milnacipran on sleep disturbance in fibromyalgia. National Institutes of Health. http://clinicaltrials.gov/ct2/show/NCT01234675?term=fibromyalgia&rank=77. Accessed July 29, 2011.
- Vincent Ann (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 12, 2011.
Find Mayo Clinic on