Milnacipran

The Basics

What is Milnacipran?

Milnacipran is used to treat fibromyalgia.

Brand names for Milnacipran

Savella

How Milnacipran is classified

Adrenergic Uptake Inhibitors, Antidepressive Agents, Serotonin Uptake Inhibitors

Milnacipran During Pregnancy

Milnacipran pregnancy category

Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.

What we know about taking Milnacipran while pregnant

N/A

Taking Milnacipran While Breastfeeding

What are recommendations for lactation if you're taking Milnacipran?

Milnacipran has not been studied in nursing mothers and the manufacturer recommends that nursing mothers not take milnacipran.[1] Because no information is available on the use of milnacipran during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

Maternal / infant drug levels

Milnacipran has not been studied in nursing mothers and the manufacturer recommends that nursing mothers not take milnacipran.[1] Because no information is available on the use of milnacipran during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

Possible effects of Milnacipran on milk supply

Galactorrhea is reported by the manufacturer to be a side effect of milnacipran.[1] One woman who was being treated for depression took an intentional overdose of 950 mg of milnacipran orally. From day 5 to day 15 after the overdose, the patient noted a flow of milk from her left breast. The galactorrhea resolved without treatment.[2]

In a study of cases of hyperprolactinemia and its symptoms (e.g., gynecomastia) reported to a French pharmacovigilance center, milnacipran was not found to have an increased risk of causing hyperprolactinemia compared to other drugs.[3]

An observational study looked at outcomes of 2859 women who took an antidepressant during the 2 years prior to pregnancy. Compared to women who did not take an antidepressant during pregnancy, mothers who took an antidepressant during all 3 trimesters of pregnancy were 37% less likely to be breastfeeding upon hospital discharge. Mothers who took an antidepressant only during the third trimester were 75% less likely to be breastfeeding at discharge. Those who took an antidepressant only during the first and second trimesters did not have a reduced likelihood of breastfeeding at discharge.[4] The antidepressants used by the mothers were not specified.

A retrospective cohort study of hospital electronic medical records from 2001 to 2008 compared women who had been dispensed an antidepressant during late gestation (n = 575) to those who had a psychiatric illness but did not receive an antidepressant (n = 1552) and mothers who did not have a psychiatric diagnosis (n = 30,535). Women who received an antidepressant were 37% less likely to be breastfeeding at discharge than women without a psychiatric diagnosis, but no less likely to be breastfeeding than untreated mothers with a psychiatric diagnosis.[5] None of the mothers were taking milnacipran.

Possible alternatives to Milnacipran

Duloxetine, Pregabalin.