Drug interactions
Desipramine + Milnacipran
Severity: Major
Desipramine and Milnacipran: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Both drugs increase synaptic serotonin and norepinephrine, so combining them increases the risk of serotonin syndrome and of hypertension and tachycardia. Milnacipran may also modestly increase cardiovascular strain in patients on tricyclics.
What this interaction means in plain words
Desipramine and Milnacipran can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Desipramine belongs to Central Nervous System; Milnacipran belongs to Central Nervous System.
Why it happens
Additive serotonin and norepinephrine reuptake inhibition.
What to do
Avoid the combination when an alternative exists. If co-prescribed, use low doses, titrate slowly and monitor for serotonin toxicity and blood pressure changes.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Desipramine
- Desipramine + Disopyramide Contraindicated
- Desipramine + Dofetilide Contraindicated
- Desipramine + Ibutilide Contraindicated
- Desipramine + Isocarboxazid Contraindicated
- Desipramine + Methylene blue Contraindicated
- Desipramine + Pentamidine Contraindicated
Other interactions of Milnacipran
- Isocarboxazid + Milnacipran Contraindicated
- Methylene blue + Milnacipran Contraindicated
- Milnacipran + Phenelzine Contraindicated
- Milnacipran + Procarbazine Contraindicated
- Milnacipran + Rasagiline Contraindicated
- Milnacipran + Safinamide Contraindicated
Frequently asked questions
Can I take Desipramine with Milnacipran?
MediHelp rates the interaction as major. Desipramine and Milnacipran can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Both drugs increase synaptic serotonin and norepinephrine, so combining them increases the risk of serotonin syndrome and of hypertension and tachycardia. Milnacipran may also modestly increase cardiovascular strain in patients on tricyclics.
How serious is the interaction between Desipramine and Milnacipran?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination when an alternative exists. If co-prescribed, use low doses, titrate slowly and monitor for serotonin toxicity and blood pressure changes.
What other medicines interact with Desipramine?
MediHelp also lists interactions of Desipramine with, for example, Disopyramide, Dofetilide, Ibutilide. The full list is on the Desipramine page.
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