Drug interactions
Epinephrine racemic + Milnacipran
Severity: Moderate
Epinephrine racemic and Milnacipran: moderate interaction.
Last updated
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, which can amplify the pressor and cardiac effects of systemic epinephrine, leading to hypertension and arrhythmia. Inhaled racemic epinephrine has lower systemic exposure, but the risk rises with high or repeated dosing.
What this interaction means in plain words
Epinephrine racemic and Milnacipran can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Pharmacodynamic synergism from norepinephrine reuptake inhibition enhancing adrenergic stimulation.
What to do
Monitor blood pressure, heart rate and ECG when epinephrine is used in a patient on milnacipran, and use the lowest effective epinephrine dose. Epinephrine for anaphylaxis should not be withheld.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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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 Epinephrine racemic with Milnacipran?
MediHelp rates the interaction as moderate. Epinephrine racemic and Milnacipran can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Milnacipran blocks norepinephrine reuptake, which can amplify the pressor and cardiac effects of systemic epinephrine, leading to hypertension and arrhythmia. Inhaled racemic epinephrine has lower systemic exposure, but the risk rises with high or repeated dosing.
How serious is the interaction between Epinephrine racemic and Milnacipran?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood pressure, heart rate and ECG when epinephrine is used in a patient on milnacipran, and use the lowest effective epinephrine dose. Epinephrine for anaphylaxis should not be withheld.
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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