Drug interactions
Milnacipran + Perphenazine
Severity: Moderate
Milnacipran and Perphenazine: 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
Use of an SNRI with perphenazine may rarely lead to serotonin syndrome or neuroleptic malignant syndrome. Milnacipran has little CYP2D6 effect, so the main concern is pharmacodynamic.
What this interaction means in plain words
Milnacipran and Perphenazine 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 belongs to Central Nervous System; Perphenazine belongs to Central Nervous System.
Why it happens
Additive serotonergic and dopaminergic modulation; the mechanism of the rare syndromes is not fully established.
What to do
Monitor for fever, rigidity, tremor, agitation and autonomic instability, especially at initiation and dose changes. Stop the drugs and treat supportively if a syndrome develops.
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
Other interactions of Perphenazine
- Ibutilide + Perphenazine Contraindicated
- Perphenazine + Pimozide Contraindicated
- Perphenazine + Thioridazine Contraindicated
- Adagrasib + Perphenazine Major
- Alfentanil + Perphenazine Major
- Amiodarone + Perphenazine Major
Frequently asked questions
Can I take Milnacipran with Perphenazine?
MediHelp rates the interaction as moderate. Milnacipran and Perphenazine 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. Use of an SNRI with perphenazine may rarely lead to serotonin syndrome or neuroleptic malignant syndrome. Milnacipran has little CYP2D6 effect, so the main concern is pharmacodynamic.
How serious is the interaction between Milnacipran and Perphenazine?
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 for fever, rigidity, tremor, agitation and autonomic instability, especially at initiation and dose changes. Stop the drugs and treat supportively if a syndrome develops.
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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