Milnacipran Hydrochloride is indicated for the management of fibromyalgia.

Fibromyalgia

• Administer Milnacipran Hydrochloride in two divided doses per day
• Based on efficacy and tolerability, dosing may be titrated according to the following schedule 
• Day 1: 12.5 mg once Days 2-3: 25 mg/day (12.5 mg twice daily)
• Days 4-7: 50 mg/day (25 mg twice daily)
• After Day 7: 100 mg/day (50 mg twice daily)
• Recommended dose is 100 mg/day 
• May be increased to 200 mg/day based on individual patient response 
• Dose should be adjusted in patients with severe renal impairment

Most common adverse reactions associated with the use of milnacipran HCl include-

• nausea
• headache
• constipation
• dizziness
• insomnia
• hot flush
• hyperhidrosis
• vomiting
• palpitations
• heart rate increased
• dry mouth
• hypertension

Nausea	Headache	Constipation
Dizziness	Insomnia (Difficulty in Falling asleep)	Hypertension (Hight Blood Pressure)

• Suicidality: Monitor for worsening of depressive symptoms and suicide risk
• Serotonin Syndrome or Neuroleptic Malignant Syndrome (NMS)-like Reactions: Serotonin syndrome or NMS-like reactions have been reported with SNRIs and SSRIs.  Discontinue Milnacipran Hydrochloride and initiate supportive treatment
• Elevated blood pressure and heart rate: Cases have been reported with Milnacipran Hydrochloride. Monitor blood pressure and heart rate prior to initiating treatment with Milnacipran Hydrochloride and periodically throughout treatment
• Seizures: Cases have been reported with Milnacipran Hydrochloride therapy. Prescribe Milnacipran Hydrochloride with care in patients with a history of seizure disorder 
• Hepatotoxicity: More patients treated with Milnacipran Hydrochloride than with placebo experienced mild elevations of ALT and AST. Rarely, fulminant hepatitis has been reported in patients treated with Milnacipran Hydrochloride. Avoid concomitant use of Milnacipran Hydrochloride in patients with substantial alcohol use or chronic liver disease 
• Discontinuation: Withdrawal symptoms have been reported in patients when discontinuing treatment with Milnacipran Hydrochloride. A gradual dose reduction is recommended 
• Abnormal Bleeding: Milnacipran Hydrochloride may increase the risk of bleeding events. Caution patients about the risk of bleeding associated with the concomitant use of Milnacipran Hydrochloride and NSAIDs, aspirin, or other drugs that affect coagulation
• Male patients with a history of obstructive uropathies may experience higher rates of genitourinary adverse events