David Baxter PhD
Late Founder
Milnacipran (Savella) for fibromyalgia: What makes it different?
by Ann Vincent, M.D., Mayo Clinic
July 28, 2009
How is milnacipran, the new fibromyalgia drug, different from other fibromyalgia medications?
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.
References
by Ann Vincent, M.D., Mayo Clinic
July 28, 2009
How is milnacipran, the new fibromyalgia drug, different from other fibromyalgia medications?
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.
References
- Savella (prescribing information). New York, N.Y.: Forest Pharmaceuticals, Inc.; 2009. http://www.frx.com/pi/Savella_pi.pdf
- 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.
