From the FDA Drug Label
Taper milnacipran hydrochloride tablets and do not abruptly discontinue after extended use [see Dosage and Administration (2. 4) and Warnings and Precautions (5.7)]. To titrate off Savella 50mg bid, taper the dose, but the FDA label does not provide a specific tapering schedule.
- The label only advises to taper and not to abruptly discontinue after extended use 1.
From the Research
The recommended tapering schedule for discontinuing Savella (milnacipran) 50mg twice daily is to gradually reduce the dose over at least 2 weeks, rather than stopping abruptly. A typical approach would be to decrease to 25mg twice daily for 7 days, then 25mg once daily for 7 days, before complete discontinuation. For patients who have been on Savella for longer periods or who have experienced withdrawal symptoms previously, a more gradual taper over 4-6 weeks may be appropriate. During the tapering process, patients should monitor for withdrawal symptoms such as dizziness, nausea, headache, irritability, insomnia, diarrhea, anxiety, fatigue, or abnormal sensations like electric shock feelings. Gradual tapering is necessary because Savella affects both serotonin and norepinephrine neurotransmitters, and abrupt discontinuation can cause these neurotransmitter systems to fluctuate rapidly, leading to withdrawal symptoms 2. If withdrawal symptoms occur during tapering, slowing the taper rate by extending the time between dose reductions may help minimize discomfort. Some key points to consider when tapering off Savella include:
- The dose range is 50-200 mg, in divided doses 2
- Milnacipran has a half-life of approximately 8 hours, reaches steady state in 2 days, and is excreted renally 2
- Caution is necessary in the presence of heart disease, hypertension, renal impairment, epilepsy, glaucoma, bipolar disorder, and bleeding tendency 2
- Milnacipran may be useful for patients with depression and pain, and endogenous depression characterized by anergia, psychomotor retardation, and hypersomnia 2