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Milnacipran

Milnacipran is an SNRI (a type of medication that affects serotonin and norepinephrine in the brain) used to manage fibromyalgia in adults.

Brand name Savella
Drug class Serotonin And Norepinephrine Reuptake Inhibitor
Rx Form 1
Dr. Brian Staiger, PharmD, BCPS
Reviewed by Last reviewed Jul 10, 2026 Content updated Oct 2, 2026
🧬 Where this information comes from Click to expand

The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 6 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →

✓No current FDA shortage listed · checked Oct 5, 2026
Milnacipran at a glance The quick version — the full detail is in the Patient Information Guide below.
Dr. Brian Staiger, PharmD, BCPS
The Pharmacist’s Take By · Clinical pharmacist · Written

Milnacipran (Savella) is an SNRI, a drug that boosts two brain messengers, serotonin and norepinephrine, to dampen pain signals; it is one of a few medicines approved for fibromyalgia in adults, on the market since about 2009 and available as a generic. Nausea is the side effect most people notice early on, along with headache, constipation, sweating and a faster heartbeat. It is not approved for depression but carries a boxed warning about suicidal thoughts in young people, so watch for new mood changes, especially in the first weeks. It also raises blood pressure and heart rate, so get yours checked before starting and regularly after.

Clinical pearls

  • Take each dose with a meal, since food often softens the nausea that is common in the first weeks.
  • Tell every prescriber you take it, since tramadol, triptans, other antidepressants and St. John's Wort can trigger serotonin syndrome.
  • Never stop it suddenly, even if it seems not to be working; your prescriber will taper it to avoid withdrawal symptoms.
  • Regular ibuprofen, naproxen or aspirin use adds to its bleeding risk, so report unusual bruising or bleeding.
How we write & review this content — our editorial policy →
⚠️ FDA Boxed Warning — the FDA’s strongest safety alert ▾

Important warning about suicidal thoughts: Milnacipran belongs to a class of drugs similar to antidepressants. Studies show that antidepressants can increase the risk of suicidal thinking and behavior in children, teenagers, and young adults (especially those under 25) when used for depression or other psychiatric conditions. Closely watch anyone starting milnacipran — especially young adults — for new or worsening thoughts of suicide, unusual mood changes, agitation, or behavioral changes, and contact the prescriber right away if these occur. This risk is most important during the first few weeks of treatment or after a dose change. Families and caregivers should be involved in monitoring. Note: milnacipran is not approved to treat depression, and it is not approved for anyone under 18.

Read the full warning on DailyMed →
How you get itPrescription only
Comes asTablet
Earliest FDA record2009
Companies listing it with the FDA7
FDA label last updatedMar 19, 2026
FDA’s strongest warning (boxed)Yes, read the warning

Patient information guide A plain-language walkthrough of Milnacipran, written from its FDA label.

What Milnacipran is used for

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Milnacipran is an SNRI used to manage fibromyalgia in adults.

  • Milnacipran Hydrochloride tablets are indicated for the management of fibromyalgia
  • Savella (milnacipran) tablets are indicated for the management of fibromyalgia
  • Milnacipran is not approved to treat major depressive disorder or any other psychiatric condition
  • Milnacipran is not approved for use in patients under 18 years of age

How Milnacipran works

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Milnacipran is a serotonin-norepinephrine reuptake inhibitor (SNRI). It works by preventing the brain from reabsorbing two neurotransmitters — norepinephrine and serotonin — leaving more of them active in the nervous system. It preferentially blocks norepinephrine reuptake with about three times the potency of serotonin reuptake. Although the exact reason this helps fibromyalgia pain is not fully understood, it is thought to involve the brain's ability to dampen pain signals. Milnacipran does not significantly bind to a wide range of other brain receptors (such as those for histamine, dopamine, or acetylcholine), which distinguishes it from older medications and may limit certain side effects.

Milnacipran dosage

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Milnacipran tablets are taken by mouth twice a day. They can be taken with or without food, though food may help with stomach upset. The dose is started low on day one and gradually stepped up over the course of about a week to improve tolerability — your prescriber will give you a specific schedule to follow.

  • Do not stop taking milnacipran suddenly; the dose should be tapered gradually
  • If you have significant kidney problems, your dose may need to be adjusted or the medication may not be appropriate for you
  • Always follow your prescriber's exact instructions — do not adjust your dose on your own

Dosing details from the FDA-approved label

From the Milnacipran prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.

  • General dosing (recommended dosing)
    • Recommended dose is 100 mg/day (50 mg twice daily), given orally in two divided doses per day with or without food
    • Titration based on efficacy and tolerability: Day 1: 12.5 mg once
    • Days 2 to 3: 25 mg/day (12.5 mg twice daily)
    • Days 4 to 7: 50 mg/day (25 mg twice daily)
    • After Day 7: 100 mg/day (50 mg twice daily)
    • Based on individual patient response, may
    • Maximum: Doses above 200 mg/day have not been studied
    • Taking with food may improve tolerability; taper and do not abruptly discontinue after extended use
  • Patients with severe renal impairment (estimated creatinine clearance of 5 to 29 mL/min)
    • Reduce the maintenance dose by 50% to 50 mg/day (25 mg twice daily)
    • Based on individual patient response, may be increased to 100 mg/day (50 mg twice daily)
    • Not recommended for end-stage renal disease; no adjustment for mild renal impairment; use caution in moderate renal impairment
  • Patients with hepatic impairment
    • No dosage adjustment is necessary
    • Exercise caution in patients with severe hepatic impairment
Read the label’s full dosing text

2 DOSAGE AND ADMINISTRATION Milnacipran hydrochloride tablets are given orally with or without food. Taking milnacipran hydrochloride tablets with food may improve the tolerability of the drug. • Administer milnacipran hydrochloride tablets in two divided doses per day (2.1) . • Based on efficacy and tolerability, dosing may be titrated according to the following schedule (2.1) : Day 1: 12.5 mg once Days 2 to 3: 25 mg/day (12.5 mg twice daily) Days 4 to 7: 50 mg/day (25 mg twice daily) After Day 7: 100 mg/day (50 mg twice daily) • Recommended dose is 100 mg/day (2.1) . • May be increased to 200 mg/day based on individual patient response (2.1) . • Adjust dose in patients with severe renal impairment (2.2) . 2.1 Recommended Dosing The recommended dose of milnacipran hydrochloride tablet is 100 mg/day (50 mg twice daily). Based on efficacy and tolerability dosing may be titrated according to the following schedule: Day 1: 12.5 mg once Days 2 to 3: 25 mg/day (12.5 mg twice daily) Days 4 to 7: 50 mg/day (25 mg twice daily) After Day 7: 100 mg/day (50 mg twice daily) Based on individual patient response, the dose may be increased to 200 mg/day (100 mg twice daily). Doses above 200 mg/day have not been studied. Taper milnacipran hydrochloride tablets and do not abruptly discontinue after extended use [see Dosage and Administration (2.4) , Warnings and Precautions (5.7) ]. 2.2 Patients with Renal Insufficiency No dosage adjustment is necessary in patients with mild renal impairment. Use milnacipran hydrochloride tablets with caution in patients with moderate renal impairment. For patients with severe renal impairment (indicated by an estimated creatinine clearance of 5 to 29 mL/min), reduce the maintenance dose by 50% to 50 mg/day (25 mg twice daily). Based on individual patient response, the dose may be increased to 100 mg/day (50 mg twice daily). Milnacipran hydrochloride tablets are not recommended for patients with end-stage renal disease. 2.3 Patients with Hepatic Insufficiency No dosage adjustment is necessary for patients with hepatic impairment. As with any drug, exercise caution in patients with severe hepatic impairment.

Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →

Milnacipran side effects

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The most common side effects reported in clinical trials include:

Common side effects

  • Nausea
  • Headache
  • Constipation
  • Dizziness
  • Insomnia (trouble sleeping)
  • Hot flushes and excessive sweating
  • Palpitations (noticeable heartbeat) or faster heart rate
  • High blood pressure
  • Dry mouth
  • Vomiting

When to get medical help

  • Seek emergency help if you notice signs of serotonin syndrome: agitation, hallucinations, rapid heartbeat, fever, severe muscle twitching, or loss of coordination
  • Call your doctor right away if your blood pressure rises significantly or you develop chest pain
  • Get help immediately if you have thoughts of suicide or self-harm, or notice unusual changes in mood or behavior
  • Contact your doctor if you experience signs of liver problems: yellowing of the skin or eyes, dark urine, severe stomach pain
  • Tell your doctor if you have unusual bleeding or bruising, especially if you also take aspirin, NSAIDs, or blood thinners
  • Seek care for seizures (convulsions) — cases have been reported with milnacipran
  • Call your doctor if you develop difficulty urinating, especially if you are male with a history of urinary problems

More serious reactions — including serotonin syndrome, significant blood pressure increases, liver problems, abnormal bleeding, and seizures — have been reported. Contact your doctor or seek emergency care right away if any of these occur.

Milnacipran warnings and precautions

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  • Suicidal thinking: Like other SNRI-class drugs, milnacipran is associated with an increased risk of suicidal thoughts in children, adolescents, and young adults. Monitor closely, especially early in treatment or after dose changes. Milnacipran is not approved for anyone under 18.
  • Serotonin syndrome: A potentially life-threatening condition can occur if milnacipran is combined with MAOIs or other serotonergic drugs. Symptoms include agitation, hallucinations, rapid heartbeat, fever, muscle twitching, and loss of coordination. Seek emergency help immediately.
  • High blood pressure and heart rate: Milnacipran can meaningfully raise blood pressure and heart rate. Blood pressure should be checked before starting and monitored regularly during treatment.
  • Bleeding risk: Milnacipran affects how platelets work, increasing bleeding risk — especially when combined with NSAIDs, aspirin, or blood thinners.
  • Liver concerns: Milnacipran can raise liver enzymes. Avoid heavy alcohol use or use in people with chronic liver disease.
  • Discontinuation symptoms: Do not stop milnacipran abruptly. A gradual taper is needed to avoid withdrawal-like symptoms.
  • Seizures: Cases have been reported; use with caution if you have a seizure history.
  • Urinary problems in men: Men with a history of obstructive urinary conditions may experience higher rates of urinary side effects.

Milnacipran interactions

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Milnacipran has few pharmacokinetic (blood level) drug interactions because it is mostly excreted unchanged and does not significantly affect liver enzymes. However, it does have important pharmacodynamic (how it acts) interactions:

  • MAOIs (e.g., phenelzine, tranylcypromine, linezolid, IV methylene blue) — dangerous serotonin syndrome risk; strictly contraindicated; a washout period is required before switching
  • Other serotonergic drugs (SSRIs, SNRIs, triptans, tricyclic antidepressants, tramadol, fentanyl, meperidine, methadone, lithium, tryptophan, buspirone, amphetamines, St. John's Wort) — increased serotonin syndrome risk
  • Epinephrine and norepinephrine — may cause dangerous blood pressure spikes or heart rhythm problems
  • IV digoxin — may worsen heart-related side effects including low blood pressure and rapid heart rate; avoid this combination
  • Clonidine — milnacipran may reduce clonidine's blood-pressure-lowering effect
  • NSAIDs, aspirin, warfarin, and other antiplatelet or anticoagulant drugs — increased risk of bleeding
  • Clomipramine — switching from clomipramine without a washout period may cause low blood pressure and euphoria

Interactions listed in the FDA-approved label

From the Milnacipran prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.

  • Monoamine oxidase inhibitors (MAOIs) intended to treat psychiatric disorders: Concomitant use of SSRIs and SNRIs, including milnacipran, with MAOIs increases the risk of serotonin syndrome; use with an MAOI or within 5 days of stopping milnacipran, or within 14 days of stopping an MAOI, is contraindicated. Allow at least 14 days after stopping an MAOI before starting milnacipran, and at least 5 days after stopping milnacipran before starting an MAOI.
  • Linezolid or intravenous methylene blue (MAOIs): Increased risk of serotonin syndrome. Do not initiate milnacipran in a patient being treated with them; if treatment is necessary in a patient taking milnacipran, discontinue milnacipran before initiating the MAOI.
  • Other serotonergic drugs (other SNRIs, SSRIs, triptans, tricyclic antidepressants, opioids, lithium, tryptophan, buspirone, amphetamines, St. John's Wort): Serotonin syndrome can occur with milnacipran and other serotonergic drugs. Advise patients of the signs and symptoms of serotonin syndrome and to seek medical care immediately if they occur.
  • Triptans: There have been rare postmarketing reports of serotonin syndrome with use of an SSRI and a triptan. If concomitant treatment is clinically warranted, careful observation is advised, particularly during treatment initiation and dose increases.
  • Epinephrine and norepinephrine (catecholamines): Concomitant use may be associated with paroxysmal hypertension and possible arrhythmia because milnacipran inhibits norepinephrine reuptake.
  • Other CNS-active drugs (including clomipramine): In a drug-drug interaction study, an increase in euphoria and postural hypotension was observed in patients who switched from clomipramine to milnacipran. Use caution when taken in combination with other centrally acting drugs.
  • Digoxin: May be associated with potentiation of adverse hemodynamic effects; postural hypotension and tachycardia were reported with intravenous digoxin (1 mg). Avoid co-administration of milnacipran and intravenous digoxin.
  • Clonidine: Co-administration may inhibit clonidine's anti-hypertensive effect because milnacipran inhibits norepinephrine reuptake.
  • Antiplatelet or anticoagulant drugs (e.g., NSAIDs, aspirin, warfarin): Concomitant use may potentiate the risk of bleeding. Closely monitor for bleeding when milnacipran is initiated or discontinued.
Read the label’s full interactions text

7 DRUG INTERACTIONS Milnacipran undergoes minimal CYP450 related metabolism, with the majority of the dose excreted unchanged in urine (55%) and has a low binding to plasma proteins (13%). In vitro and in vivo studies showed that milnacipran hydrochloride is unlikely to be involved in clinically significant pharmacokinetic drug interactions [see Pharmacokinetics in Special Populations ( 12.3 )] . • Milnacipran hydrochloride is unlikely to be involved in clinically significant pharmacokinetic drug interactions ( 7 ). • Pharmacodynamic interactions of milnacipran hydrochloride with other drugs can occur ( 7 ). 7.1 Monoamine Oxidase Inhibitors (MAOIs) The concomitant use of SSRIs and SNRIs, including milnacipran hydrochloride, with MAOIs increases the risk of serotonin syndrome. The use of MAOIs intended to treat psychiatric disorders with milnacipran hydrochloride or within 5 days of stopping treatment with milnacipran hydrochloride is contraindicated. The use of milnacipran hydrochloride within 14 days of stopping an MAOI intended to treat psychiatric disorders is also contraindicated. In addition, do not initiate milnacipran hydrochloride in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue. No reports involved the administration of methylene blue by other routes (such as oral tablets or local tissue injection). If it is necessary to initiate treatment with a MAOI such as linezolid or intravenous methylene blue in a patient taking milnacipran hydrochloride, discontinue milnacipran hydrochloride before initiating treatment with the MAOI [see Dosage and Administration ( 2.5 , 2.6 ), Contraindications ( 4 ), Drug Interactions ( 7.1 )] . 7.2 Serotonergic Drugs Serotonin syndrome can occur with use of milnacipran hydrochloride and other serotonergic drugs (other SNRIs, SSRIs, triptans, tricyclic antidepressants, opioids, lithium, tryptophan, buspirone, amphetamines, and St.

Excerpted — the section continues on the label. Read the full Drug Interactions section on DailyMed →

Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.

Check Milnacipran against a supplement or herb →

Before taking Milnacipran

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  • Tell your doctor about all medications you take, especially MAOIs, antidepressants, triptans, blood thinners, and pain relievers like NSAIDs
  • Inform your doctor if you have kidney disease — milnacipran is primarily cleared by the kidneys, and those with severe impairment need a lower dose; it is not recommended for end-stage kidney disease
  • Tell your doctor if you have liver disease or drink alcohol heavily — caution is needed, especially with severe liver impairment
  • Disclose any history of high blood pressure or heart problems — milnacipran can raise blood pressure and heart rate
  • Tell your doctor if you have a history of seizures
  • Men with a history of urinary obstruction or difficulty urinating should discuss this with their doctor before starting
  • If you are pregnant or planning to become pregnant: using milnacipran late in pregnancy may cause complications in the newborn and may increase the risk of postpartum hemorrhage — discuss the risks and benefits with your doctor
  • If you are breastfeeding: milnacipran passes into breast milk; monitor the infant for agitation, irritability, poor feeding, and poor weight gain
  • Milnacipran is not approved for patients under 18
  • Older adults should have kidney function assessed before starting, since milnacipran levels may be higher due to age-related decline in kidney function

Milnacipran overdose

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Taking too much milnacipran can cause increased blood pressure, changes in consciousness (from drowsiness to coma), confusion, dizziness, and in serious cases, cardiac and respiratory problems. There is no specific antidote. If an overdose is suspected, call Poison Control or go to the nearest emergency room immediately — do not try to induce vomiting.

What Milnacipran does in the body

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Milnacipran can raise blood pressure and heart rate, effects that have been measured in clinical studies. In studies of fibromyalgia patients, a meaningful proportion of those taking milnacipran developed blood pressure readings in the high range compared with those taking placebo, making blood pressure monitoring an important part of treatment. At doses far above the therapeutic range, milnacipran produced a small increase in the QTcF interval (a measure of heart electrical activity), but this was not considered clinically significant.

How your body processes Milnacipran

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Milnacipran is well absorbed when taken by mouth — about 85–90% of a dose reaches the bloodstream — and food does not affect absorption. It reaches peak blood levels within 2 to 4 hours and has a half-life (the time for the body to eliminate half the drug) of about 6 to 8 hours, so steady levels are reached within about 36 to 48 hours of regular dosing. Unlike many medications, milnacipran is mostly excreted unchanged through the kidneys (about 55% of the dose), which means kidney function has a significant impact on how the drug behaves in the body. It has very low binding to blood proteins (13%) and does not meaningfully inhibit or induce the liver enzymes (CYP450) responsible for metabolizing many other drugs, which limits most pharmacokinetic drug interactions.

How to store Milnacipran

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Store at 25°C (77°F); excursions permitted between 15°C and 30°C (between 59°F and 86°F) .

Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →

Milnacipran: pharmacist answers to common questions

Quick, plain-English answers to the questions patients ask most about Milnacipran — the kind of thing our pharmacy team would talk through with you at the counter.

What exactly is milnacipran used for — is it an antidepressant?

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Great question, because it's a common source of confusion. Milnacipran belongs to a class of drugs called SNRIs, which are also used to treat depression — but milnacipran itself is only FDA-approved for fibromyalgia. It is not approved to treat depression or any other psychiatric condition. If your prescriber put you on it, it's specifically to help manage your fibromyalgia symptoms.

Nausea seems really common with this medication — is there anything I can do about it?

▾
Yes, nausea is the most common side effect, but there's a practical tip: try taking your tablet with food. The label specifically notes that taking milnacipran with food can help improve tolerability. The nausea often improves as your body adjusts, especially because the dose is started low and gradually increased. If it's persistent or severe, let your prescriber know — they may adjust how quickly your dose is increased.

I heard this can affect my blood pressure. Should I be monitoring it at home?

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That's a smart thing to pay attention to. Milnacipran can raise both blood pressure and heart rate in some people, and your doctor should check your blood pressure before you start and periodically throughout treatment. If you have a home blood pressure cuff, it's not a bad idea to track it, especially in the first few weeks. If you notice big spikes or develop headaches, chest discomfort, or feel your heart racing, call your doctor promptly.

Can I just stop taking milnacipran if I decide it's not working for me?

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Please don't stop it abruptly without talking to your prescriber first. Stopping milnacipran suddenly can cause withdrawal-like symptoms. Your doctor will put together a tapering schedule — gradually reducing the dose over time — to help you come off it safely and comfortably. Always loop them in before making any changes to how you take it.

Are there medications I absolutely cannot take with milnacipran?

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Yes — the most important ones to avoid are MAOIs (a type of antidepressant or antibiotic like linezolid). Combining them with milnacipran can cause serotonin syndrome, which is a serious, potentially life-threatening reaction. There also needs to be a washout period if you're switching between milnacipran and an MAOI. Be sure your doctor and pharmacist have a complete list of everything you take — including over-the-counter drugs, supplements like St. John's Wort, and pain relievers like aspirin or ibuprofen, since those can increase the risk of bleeding.

Is it safe to take milnacipran during pregnancy or while breastfeeding?

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This is something to discuss carefully with your doctor. Using milnacipran in the later part of pregnancy has been associated with complications in newborns, such as breathing difficulties, irritability, and feeding problems. It may also increase the risk of heavy bleeding after delivery. Milnacipran also passes into breast milk, and infants should be watched for signs like agitation or poor feeding. Your doctor can help you weigh the risks and benefits based on your specific situation — don't stop or start any medication during pregnancy without their guidance.

Is Milnacipran available over the counter?

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No. Milnacipran is a prescription medicine: every Milnacipran product listed with the FDA is prescription only, so it is not sold over the counter. Your prescriber decides whether it is appropriate for you, and your pharmacist dispenses it.

When was Milnacipran first available?

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The earliest FDA record we hold for Milnacipran is from 2009: its first approval in Drugs@FDA or its earliest product listing in the NDC Directory, whichever is older. Many older medicines were in use before their first formal FDA approval, so this is the earliest date on record, not necessarily when Milnacipran was first used.

Who makes Milnacipran?

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7 companies currently list Milnacipran products in the FDA's NDC Directory, including Allergan, Inc., Camber Pharmaceuticals, Inc., Amneal Pharmaceuticals LLC. That count includes repackagers and distributors as well as manufacturers (companies that sell only the raw ingredient are not counted), so fewer companies actually make it; the label on your bottle names the one that supplied yours.

Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →

More about Milnacipran on HelloPharmacist

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Detailed data & references for Milnacipran Forms & strengths, pricing, billing codes, manufacturers, safety reports and sourcing — the data behind the page. Most people can stop here. Each section below opens on a tap.

Milnacipran forms and strengths (how it comes)

Milnacipran is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.

Need a version that does not list lactose, a gluten source, a dye or gelatin? Inactive ingredients differ by manufacturer: see Milnacipran inactive ingredients by manufacturer.

Tablet

By mouth
Brands Savella
How this form is used
What it may be used for
  • Milnacipran Hydrochloride tablets are indicated for the management of fibromyalgia in adults
  • Savella tablets are indicated for the management of fibromyalgia in adults
Important instructions
  • Milnacipran Hydrochloride and Savella tablets are taken by mouth twice daily
  • Milnacipran Hydrochloride and Savella tablets can be taken with or without food; taking with food may improve tolerability
  • Savella and Milnacipran Hydrochloride tablets are started at a low dose and gradually increased over the first week or more — follow your prescriber's titration schedule
  • Do not stop Savella or Milnacipran Hydrochloride tablets abruptly; the dose should be tapered gradually under your prescriber's guidance
Available strengths 4 strengths
12.5 mg 25 mg 50 mg 100 mg
59 FDA-listed product records ⓘ

Milnacipran on the U.S. market: products, makers and brands

How Milnacipran appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.

7 companies list 27 Milnacipran product records with the FDA, mostly as tablet; the earliest marketing or approval year on record is 2009. Brand names on the directory include Savella; the rest are generics.

1
Dose forms ⓘ
7
Labelers (makers, repackagers, distributors)
3
Brand names
27
FDA-listed product records ⓘ
2009
Earliest FDA record ⓘ

Also listed with the FDA, not a patient dose form: Kit (6) · Powder (5) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.

Allergan, Inc.19%
Camber Pharmaceuticals, Inc.19%
Amneal Pharmaceuticals LLC15%
Breckenridge Pharmaceutical, Inc.15%
Glenmark Pharmaceuticals Inc., USA15%
Macleods Pharmaceuticals Limited15%
Other makers4%

Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.

How widely Milnacipran is used (Medicaid data)

A general measure of how commonly Milnacipran is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.

Think of this as a proxy for how widely Milnacipran is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.

28,086
Medicaid prescriptions filled (Q1–Q4 2025)
$15.1M gross Medicaid reimbursement (before mandatory rebates — net cost is lower)

How commonly is Milnacipran prescribed? Of the 1,601 medications we measure, Milnacipran ranks #749 by Medicaid prescriptions — more than 53% of them.

Where Milnacipran ranks among the drugs we measure · Q1–Q4 2025 · neighbors ±5
Total prescriptions — #749 of 1,601
#744 Mesalamine Rectal 29,129 Rx #745 Magnesium Citrate 28,753 Rx #746 Bortezomib 28,636 Rx #747 Bethanechol 28,635 Rx #748 Magnesium Sulfate / Po... 28,515 Rx #749 Milnacipran 28,086 Rx #750 Magnesium Sulfate / Po... 27,756 Rx #751 Alirocumab Injection 27,746 Rx #752 Dexmedetomidine 27,524 Rx #753 Golimumab Injection 27,172 Rx #754 Metronidazole Injectio... 27,056 Rx

Utilization by Milnacipran product

Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.

The 50 mg oral tablet is the most-dispensed Milnacipran product — about 44% of these Medicaid prescriptions.

milnacipran hydrochloride 50 MG Oral Tablet Most dispensed

12,231 Medicaid prescriptions (Q1–Q4 2025) 44% of Milnacipran prescriptions shown $6.7M gross reimbursement (before rebates) ≈ $552 per prescription (gross)

Summed across the 1 of 12 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 833144

milnacipran hydrochloride 100 MG Oral Tablet

8,900 Medicaid prescriptions (Q1–Q4 2025) 32% of Milnacipran prescriptions shown $4.8M gross reimbursement (before rebates) ≈ $536 per prescription (gross)

Summed across the 1 of 10 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 833135

milnacipran hydrochloride 25 MG Oral Tablet

4,141 Medicaid prescriptions (Q1–Q4 2025) 15% of Milnacipran prescriptions shown $2.2M gross reimbursement (before rebates) ≈ $536 per prescription (gross)

Summed across the 1 of 10 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 833147

milnacipran hydrochloride 12.5 MG Oral Tablet

2,150 Medicaid prescriptions (Q1–Q4 2025) 8% of Milnacipran prescriptions shown $1.1M gross reimbursement (before rebates) ≈ $496 per prescription (gross)

Summed across the 1 of 9 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 833141

Other Milnacipran products — combination packs and listings not yet matched to a specific clinical product (kept visible so every prescription is accounted for)

664 Medicaid prescriptions (Q1–Q4 2025) 2% of Milnacipran prescriptions shown $298,116 gross reimbursement (before rebates) ≈ $449 per prescription (gross)

Summed across the 1 of 7 listed NDC products with Medicaid activity.

Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.

Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Milnacipran, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 5 of 48 listed Milnacipran NDCs with Medicaid activity.

Compare Milnacipran products

A representative set of FDA-listed product records for Milnacipran — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)

Showing 27 of 27 products — FDA National Drug Code Directory. See every product, package size and price: browse all 27 Milnacipran NDCs →

Milnacipran recall history

A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.

The FDA’s enforcement reports list no Milnacipran recalls since July 2021.

✅No Milnacipran recalls on record since July 2021

Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.

RxNorm Concept Web — From Ingredient to Every Form and Strength

This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.

Ingredient (IN) Milnacipran RxCUI 588250 1 dose form · 4 strengths

Look up RxCUI 588250 in the RxCUI Atlas →

RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.

💵 What Milnacipran costs pharmacies (NADAC benchmark)

The national average invoice price pharmacies pay for the drug itself, from CMS's NADAC survey (data as of Sep 30, 2026). This is a supply-cost benchmark — not a retail price and not what you'd pay at the counter.

FormStrengthPharmacy acquisition benchmark
Tablet, Film Coated · Oral 50 mg $8.16 per tablet NDC details & price history
Tablet, Film Coated · Oral 100 mg $8.15 per tablet NDC details & price history
Tablet, Film Coated · Oral 12.5 mg $8.16 per tablet NDC details & price history
Tablet, Film Coated · Oral 25 mg $8.16 per tablet NDC details & price history
Why show this? Your out-of-pocket cost depends on insurance, pharmacy markup, and discounts — but the acquisition benchmark tells you whether the medication itself is inexpensive or costly, which strengths cost more per dose, and whether a cash-price quote is in a reasonable range. Each row links to the NDC-level record with its full price history.

Source: CMS National Average Drug Acquisition Cost (NADAC), a survey of retail pharmacy invoice prices. Benchmarks shown are the range across package sizes of a representative product for each form and strength — other manufacturers' products may differ.

Milnacipran brand names

Milnacipran is sold under one brand name in the FDA directory — Savella. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.

Savella

Who makes Milnacipran: manufacturers and labelers

7 companies list Milnacipran products with the FDA. By number of product records, the largest are Allergan, Inc., Camber Pharmaceuticals, Inc., Amneal Pharmaceuticals LLC. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.

Allergan, Inc. 5 Camber Pharmaceuticals, Inc. 5 Amneal Pharmaceuticals LLC 4 Breckenridge Pharmaceutical, Inc. 4 Glenmark Pharmaceuticals Inc., USA 4 Macleods Pharmaceuticals Limited 4 Cardinal Health 107, LLC 1

Milnacipran drug class (RxNorm)

Milnacipran belongs to the Serotonin and Norepinephrine Reuptake Inhibitor class.

Pharmacologic class Serotonin and Norepinephrine Reuptake Inhibitor
Drug family (ATC) Other antidepressants
How it works Norepinephrine Uptake Inhibitors, Serotonin Uptake Inhibitors

Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.

Sources for this Milnacipran page

Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.

📄
FDA-filed drug labels (SPL) Uses, dosing, warnings & side effects from SPL records retrieved through openFDA; the linked representative set can be verified on DailyMed. ✓ Linked label effective Mar 19, 2026
🏭
Forms, brands & labelersAggregated from ingredient-matched FDA National Drug Code Directory product records for Milnacipran.
📈
Real-world reportsThe FDA Adverse Event Reporting System (FAERS), served through openFDA.
🚨
Recalls & shortagesopenFDA drug-enforcement reports and the FDA drug-shortage database.
🧾 Clinical label set — FDA-filed SPL labels retained for Milnacipran after exact ingredient or ingredient-combination matching and applicable route/form matching
Clinical labels in scope
6
Finished products in the current FDA directory
27
Companies listing them (makers, repackagers, distributors)
7
FDA labeler codes behind them ⓘ
7
Linked representative label ⓘ
Glenmark Pharmaceuticals Inc., USA
Linked label effective
Mar 19, 2026
Composite sections available
26
Linked SPL Set ID
b66b1850-0d2a-41d6-b0ad-c676166394c7
Linked SPL Document ID
97a7eb14-fa99-40e4-91c2-be5b34f5e203
Open the linked representative label on DailyMed ↗

How this page is built

HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. Glenmark Pharmaceuticals Inc., USA is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →