Drug interactions
Milnacipran + Norepinephrine
Severity: Major
Milnacipran and Norepinephrine: 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 so can strengthen the pressor and cardiac effects of infused norepinephrine. This may cause marked hypertension and arrhythmias.
What this interaction means in plain words
Milnacipran and Norepinephrine 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.
Why it happens
Inhibition of norepinephrine reuptake potentiates the effects of exogenous norepinephrine.
What to do
If vasopressor support is required, begin with a low dose and titrate carefully under continuous blood pressure and ECG monitoring. Consider holding milnacipran when feasible.
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
Frequently asked questions
Can I take Milnacipran with Norepinephrine?
MediHelp rates the interaction as major. Milnacipran and Norepinephrine 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 so can strengthen the pressor and cardiac effects of infused norepinephrine. This may cause marked hypertension and arrhythmias.
How serious is the interaction between Milnacipran and Norepinephrine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: If vasopressor support is required, begin with a low dose and titrate carefully under continuous blood pressure and ECG monitoring. Consider holding milnacipran when feasible.
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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