Drug interactions
Milnacipran + Pimavanserin
Severity: Moderate
Milnacipran and Pimavanserin: 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
Pimavanserin is a serotonin 5-HT2A inverse agonist and also prolongs the QT interval, and milnacipran is a serotonergic SNRI. Together they could rarely contribute to serotonin toxicity or neuroleptic-type reactions, though clinical data are limited.
What this interaction means in plain words
Milnacipran and Pimavanserin 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; Pimavanserin belongs to Central Nervous System.
Why it happens
Theoretical additive serotonergic and dopaminergic effects; the mechanism is not well established.
What to do
Monitor for serotonin toxicity features such as clonus, hyperthermia and agitation, and for rigidity or autonomic instability. Stop the drugs and give supportive care if these occur.
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 Pimavanserin
- Lefamulin + Pimavanserin Contraindicated
- Pimavanserin + Pimozide Contraindicated
- Pimavanserin + Vandetanib Contraindicated
- Adagrasib + Pimavanserin Major
- Amiodarone + Pimavanserin Major
- Amisulpride + Pimavanserin Major
Frequently asked questions
Can I take Milnacipran with Pimavanserin?
MediHelp rates the interaction as moderate. Milnacipran and Pimavanserin 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. Pimavanserin is a serotonin 5-HT2A inverse agonist and also prolongs the QT interval, and milnacipran is a serotonergic SNRI. Together they could rarely contribute to serotonin toxicity or neuroleptic-type reactions, though clinical data are limited.
How serious is the interaction between Milnacipran and Pimavanserin?
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 serotonin toxicity features such as clonus, hyperthermia and agitation, and for rigidity or autonomic instability. Stop the drugs and give supportive care if these occur.
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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