DRUG INTERACTIONS: The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.

To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.

Some products that may interact with this drug include: "water pills" (diuretics such as furosemide), drugs that can cause bleeding/bruising (such as "blood thinners" including warfarin/heparin, anti-platelet drugs including clopidogrel).

Avoid taking MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, selegiline, tranylcypromine) for 2 weeks before treatment, during treatment, and at least 5 days after your last dose of milnacipran. In some cases a serious, possibly fatal drug interaction may occur. Consult your doctor or pharmacist for more information.

Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (nonsteroidal anti-inflammatory drugs-NSAIDs such as aspirin, ibuprofen, naproxen) that may increase your risk for bleeding if taken together with this drug. Low-dose aspirin should be continued if prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention (usually at dosages of 81-325 milligrams per day). Consult your doctor or pharmacist for more details.

Also tell your doctor if you take any other drugs that increase serotonin, such as amphetamines (including dextroamphetamine), bromocriptine, buspirone, dextromethorphan, lithium, meperidine, propoxyphene, phentermine, tramadol, tryptophan, sibutramine, St. John's Wort, drugs used to treat migraines (including dihydroergotamine, or "triptans" such as sumatriptan), street drugs such as MDMA/"ecstasy," certain antidepressants including SSRIs (such as citalopram, paroxetine) and other SNRIs (such as duloxetine, venlafaxine).

Dextromethorphan is a commonly used cough medication and may interact with milnacipran. Check the labels on all your medicines (such as cough-and-cold products) because they may contain dextromethorphan. Ask your pharmacist about using those products safely.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: confusion, severe drowsiness/dizziness.

NOTES: Do not share this medication with others.

Laboratory and/or medical tests (such as blood pressure, heart rate, liver function) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature at 77 degrees F (25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not store in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Information last revised October 2011. Copyright(c) 2011 First Databank, Inc.