Drug interactions
Epinephrine + Milnacipran
Severity: Major
Epinephrine 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
Milnacipran blocks norepinephrine reuptake and may potentiate pressor and arrhythmic effects of injected epinephrine, causing marked hypertension and tachyarrhythmia. Labeling warns of this interaction with systemic epinephrine.
What this interaction means in plain words
Epinephrine 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.
Epinephrine belongs to Endocrine; Milnacipran belongs to Central Nervous System.
Why it happens
Additive adrenergic stimulation through norepinephrine reuptake inhibition combined with exogenous catecholamine.
What to do
Avoid systemic epinephrine when alternatives exist; if required, such as in anaphylaxis, use it and monitor blood pressure and ECG. Limit epinephrine in local anesthetic infiltration.
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 Milnacipran
- Isocarboxazid + Milnacipran Contraindicated
- Methylene blue + Milnacipran Contraindicated
- Milnacipran + Phenelzine Contraindicated
- Milnacipran + Procarbazine Contraindicated
- Milnacipran + Rasagiline Contraindicated
- Milnacipran + Safinamide Contraindicated
Other interactions of Epinephrine
- Epinephrine + Isocarboxazid Contraindicated
- Epinephrine + Phenelzine Contraindicated
- Epinephrine + Tranylcypromine Contraindicated
- Acebutolol + Epinephrine Major
- Amitriptyline + Epinephrine Major
- Amoxapine + Epinephrine Major
Frequently asked questions
Can I take Epinephrine with Milnacipran?
MediHelp rates the interaction as major. Epinephrine 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. Milnacipran blocks norepinephrine reuptake and may potentiate pressor and arrhythmic effects of injected epinephrine, causing marked hypertension and tachyarrhythmia. Labeling warns of this interaction with systemic epinephrine.
How serious is the interaction between Epinephrine 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 systemic epinephrine when alternatives exist; if required, such as in anaphylaxis, use it and monitor blood pressure and ECG. Limit epinephrine in local anesthetic infiltration.
What other medicines interact with Milnacipran?
MediHelp also lists interactions of Milnacipran with, for example, Isocarboxazid, Methylene blue, Phenelzine. The full list is on the Milnacipran page.
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