Milnacipran tablets

What is this medicine?

MILNACIPRAN (mil NA si pran) is used to treat the pain caused by fibromyalgia.

How should I use this medicine?

Take this medicine by mouth with a glass of water. You can take it with or without food. If it upsets your stomach, take it with food. Follow the directions on the prescription label. Do not take your medicine more often than directed. Do not stop taking this medicine suddenly except upon the advice of your doctor. Stopping this medicine too quickly may cause serious side effects or your condition may worsen.

A special MedGuide will be given to you by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

• anxious

• breathing problems

• confusion

• changes in vision

• chest pain

• confusion

• elevated mood, decreased need for sleep, racing thoughts, impulsive behavior

• eye pain

• fast, irregular heartbeat

• feeling faint or lightheaded, falls

• feeling agitated, angry, or irritable

• hallucination, loss of contact with reality

• high blood pressure

• loss of balance or coordination

• palpitations

• redness, blistering, peeling or loosening of the skin, including inside the mouth

• restlessness, pacing, inability to keep still

• seizures

• stiff muscles

• suicidal thoughts or other mood changes

• trouble passing urine or change in the amount of urine

• trouble sleeping

• unusual bleeding or bruising

• unusually weak or tired

• vomiting

• yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• change in sex drive or performance

• change in appetite or weight

• constipation

• dizziness

• dry mouth

• headache

• increased sweating

• nausea

• tired

What may interact with this medicine?

Do not take this medicine with any of the following medications:

• desvenlafaxine

• duloxetine

• levomilnacipran

• linezolid

• MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate

• methylene blue (injected into a vein)

• venlafaxine

This medicine may also interact with the following medications:

• amphetamines

• aspirin and aspirin-like medicines

• clonidine

• digoxin

• epinephrine

• furazolidone

• lithium

• medicines for blood pressure

• medicines for migraine headache like almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan

• medicines that treat or prevent blood clots like warfarin, enoxaparin, and dalteparin

• NSAIDS, medicines for pain and inflammation, like ibuprofen or naproxen

• other medicines for depression, anxiety, or psychotic disturbances

• procarbazine

• rasagiline

• St. John's wort, Hypericum perforatum

• tramadol

• tryptophan

What if I miss a dose?

If you miss a dose, skip that dose and take the next dose at your regular time. Do not take double or extra doses.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• bleeding disorders

• glaucoma

• heart disease

• high blood pressure

• if you often drink alcohol

• irregular heart beat

• kidney disease

• liver disease

• mania or bipolar disorder

• prostate disease

• seizures

• suicidal thoughts, plans, or attempt; a previous suicide attempt by you or a family member

• taken an MAOIs like Carbex, Eldepryl, Marplan, Nardil, and Parnate within 14 days

• an unusual or allergic reaction to milnacipran, levomilnacipran, other medicines, foods, or preservatives

• pregnant or trying to get pregnant

• breast-feeding

What should I watch for while using this medicine?

Tell your doctor if your symptoms do not get better or if they get worse. Visit your doctor or health care professional for regular checks on your progress.

Patients and their families should watch out for new or worsening thoughts of suicide or depression. Also watch out for sudden changes in feelings such as feeling anxious, agitated, panicky, irritable, hostile, aggressive, impulsive, severely restless, overly excited and hyperactive, or not being able to sleep. If this happens, especially at the beginning of treatment or after a change in dose, call your health care professional.

This medicine can cause an increase in blood pressure. Check with your doctor for instructions on monitoring your blood pressure while taking this medicine.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. Do not stand or sit up quickly, especially if you are an older patient. This reduces the risk of dizzy or fainting spells. Alcohol may interfere with the effect of this medicine. Avoid alcoholic drinks.

Your mouth may get dry. Chewing sugarless gum, sucking hard candy and drinking plenty of water will help. Contact your doctor if the problem does not go away or is severe.