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Just started taking Savella...

Posted by Melissa Bastian Patient ExpertFacebook

Has anyone tried this or Cymbalta, the other SNRI (Serotonin and Norepinephrine reuptake inhibitor) on the market?  Good/bad/indifferent results?  I'm only halfway through my titration, so it'll still be a couple of weeks before I know if the Savella is having any positive effects.
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Hi Melissa,  Yes, I am another Melissa!  ;) 

I have been on Savella for about 4 months.  I have not tried Cymbalta.  My doc describes Savella as part Lexapro/part Adderall.  I also take D-ribose(1/2-1 scoop per day),10 mg Oxycontin-(not as much since starting the Savella), Vicodin(5/500 only as needed), Provigil(1/2 per day), Flexeril(5mg at night), and vitamins(Vit D, E, B, Magnesium, Omegas).  

I have had some really great moments and some really bad moments on Savella(muscle pain, fatigue...).  It is really rocky in the beginning.  After about 2 months, I started to feel really good(like 75% better!!).  Now on my 4th month, I seem to be rolling backwards.  Not sure if it is a flare up, or if my meds are not mixing well?  I have read to stick it out, because it is worth it(I read on the clinical trial recaps, that up to month 10 you might have to stick it out?!).  I am now back to 50 mg a day(only the pm dose).  I am uncertain wether I will stay on it or not.  If it starts to get better again, I will stay on it!  

Anyone else having the same problem?  I am curious to know if any one around month 4 saw any eye twitches(I have had this for 4 wks) or a leveling effect, like it just suddenly stopped working?  I would really appreciate any info!  :)     -melissa m. 

Hi Melissa!  That certainly is a lot of medication to be dealing with.  I thought I was getting bad with my Savella, Welbutrin, Yasmin, Topamax, and occasional Flexaril and Voltaren.  My doc has also given me Ultram, but I haven't taken it.

Just this week I've reached the 100mg dose with the Savella - the titration was really difficult, even though I did it way slower than it's even intended to be.  Every time I raised the dose - even by 12.5 mg - I had to go through two days of nausea, heavy feelings, dizzyness, etc.  So far I'm doing OK on the full dose though, with the minor exception that my appetite seems to be funny.  I'm also under a lot of stress though, and it's always so hard to say which factors are causing what!  As far as whether it's helping with pain, also hard to say.  I'm back to how I was feeling a couple of months ago, but that could just be this last bad flare of mine dying down on its own.

It will be interesting to see if I continue to have problems or if I do alright.  I'm somewhat concerned because both the Savella and the Wellbutrin are inhibiting the reuptake of norepinephrine - will I end up with way too much in my brain?  Or is it like, once the receptors are blocked, they're blocked, and the second drug just becomes moot in that aspect?  I should look into whether the two drugs inhibit the same receptors - although I'll admit that that science is a bit above my head.  Ugh.  Biochem.  Dealing with new drugs is always a trial.

Oh wow...Wellbutrin AND Savella?!  That is a lot of SNRIs!  Be careful.  Also, I have seen warnings about combining Ultram and Savella!


And with Wellbutrin: 

That may explain the stomach problems too.  I experienced more pain in the beginning of the titration.  I also went reallly slow and did two titrated packages.  I am back to 50 mg per day....and I feel so much better, than the 100 mg.  I stay away from anything that might cause serotonin symdrom(too much serotonin).  And it does effect your appetite.  One of the main side effects is ---weight loss.  


Hope you are feeling better now!

-melissa  :) 

oops... I meant serotonin syndrome!  ;)

Yeah, the Wellbutrin - I always thought it was an SSRI, but it isn't - it's actually a DNRI - dopamine norepinephrine reuptake inhibitor.  I guess I didn't do my homework a few years back when I started taking it, which is weird of me.  Anyway, it has little to no effect on serotonin.  What concerns me is that both it and Savella are working on the norepinephrine - maybe that explains why I'm waking up so perky in the morning?  :P

The Ultram, though, I'm glad I looked it up before taking any.  It works exactly like an SNRI!  Doesn't really seem like a good idea to be doubling up, in my book.  And the same doc prescribed me both that and the Savella, in the same visit!  I need to see him again next week and I'm definitely going to bring that up - sort of shakes my confidence, you know?

Frustrating though, because I can't take Flexaril during the day and expect to function at all, and the non-steroidals destroy my stomach.  I certainly don't want to go the steroidal route, with all their side effects, unless I really and truly have to.  Have you, Melissa, or anyone else out there tried any other pain meds that don't have too many side effects or interactions?

I have taken Wellbutrin in the past and thought it was an SNRI!!!  Wow. Thanks for the info!!!

 I totally understand about having your confidence shaken!  I was going to an accupuncturist, who had me write down everything I was taking...she came back with a white face and explained all the negative interactions between all the herbal stuff with the prescriptions!  I stopped taking almost everything and started over.  We have so many symptoms, that it gets mixed up when they are used to writing prescriptions for everything!  I have too many doctors who don't talk to each other enough(rhuematologist, internist, accupuncturist, chiropracter, massage therapist, and the doctor who is an MD/who pracitces natural medicine!).  I now carry a list of all the meds to all my appointments, just in case.   

As for pain meds, I used to loooove Vioxx, but, my stomach was a wreck.  And it was taken off the market.  

I have been taking Oxycontin 10mg(NOT to be confused with Oxycodone-that is the generic.-which made my stomach the worst(migranes, vomiting).  But, Oxycontin is great.  It is 8 hr time released and has nothing else in it(like aspirin).  I never take more than 10mg.  I am fearful of becoming addicted, so I don't take it every day.  I have been taking it for about 1 1/2 yrs.  It is the only thing that works for me. Vicodin helps too, but, I try to avoid taking it, due to stomach issues(it has aspirin/ibuprofin or some sort of NSAID).  Also, Oxycontin will keep me up at night, so I use that during the day(when I am NOT at work) and at night Vicodin(since it lets me sleep).  I really don't take anything when I am at work.  Every so often I take Liquid Advil and Alka-seltzer(if my stomach is upset and I have pain).    

Hope this helps!! 

I would love to hear anyone else's suggestions too.  :) 

Nurses sometimes are the worst patients. I am an OR nurse. I went through years of pain,(constant dull burning with ocasional sharp shooting pains down my right arm, some numbness and tingling, but rarely. the worse of the problems was the lower back where i also had a constant burning in my lower back with sharp shoothing pains into both buttoks and down the right leg,lots of intermittent numbness, tingling, stabbing in my foot) from a car accident in 1/2006 that i "dealt with" until the symtoms worsened i couldnt take it anymore in 1/2008. Went to a pain management dr and started with an MRI of my neck, showing 2 bulging discs and severe muscle spasm, I had no curvature of the spine that should be there.The dr wanted to do epidurals and trigger point injections, I wanted a second opinion. Next, to to Spine Specialist. Prescribed physical therapy, and some flexiril and said thats all he could do for my neck. Next concerned with my lower back he ordered an MRI of my lower spine, that was never ordered by the doctor that treated me following my car accident. Surprise! 2 herniated discs, L-4 L-5 and L-5 S-1 both comproising the left exiting nerveroot. Again, PT this time some Skelaxin since the flexiril did nothing but make me sleep, and a referrel to a neurologist. Inconsistent neuro but basically "within normal limits". This doc decided I needed an MRI of my hip since I had almost abnormal results and my complaints of groin, joint, buttock and leg pain. Labral hip tear. Constant refferal from doctor to doctor every test showing something but nothing "major". Until I injured myself at work this year moving a 450lb patient, landed a trip to the ER. Finally now the pain is being taken seriously. After months of solumedrol, percocet, valium, prednisone, oxycontin increasing the doses...continuing PT for the 8 millionth time.I got a little better as I always do with PT, but then i regress after a few months. Went back to work after 2 1/2 months, apparently too soon, since I was only back at work for 3 weeks 12 1/2 hour days. I couldnt make it through a single week without leaving early because of the pain. Back out and still currently out of work. My physchiatrist, the only doctor that REALLY listens to me, I guess its his job, decided to put me on Savella. I have been taking Wellbutrin for years and had just recently lowered the dose before the work accident because things were so good in my life and I wanted to try life without drugs. Apperently not in the cards for me, but the Savella has shown some promising results. Decreases the need to take anything stronger than motrin or aleve for the pain. I just hate the dry mouth! I've also noticed an increase in my BP and get hot easily, I used to always be cold. Other than that I am pleased thus far.
i found soma 250mg-500mg helpful for a while. but the one that wroks best or me is valium 5-10mg. i hear you about destroying the stomach, ive had 3 NSAID induced stomach ulcers in the last 2 years.

Wow, Elizabeth, it sounds like you've really been through it!  Nursing is an extremely demanding job, mentally and physically - I can't imagine trying to do it while in chronic pain.  I have enough trouble dealing with my cushy desk job!

Herniated discs - aagh!  We thought I had one of those back in August.  It was awful.  I was in so much pain that I couldn't even sit at my desk and had to go home from work.  It turned out, though, just to be a pinched nerve, and nothing herniated at all.  So I can't even imagine what it's like when there's real structural damage, in multiple places no less.  Is there a way for you to work in your field but not be on your feet all day?  It sounds like it's just wrecking you!  Of course I'm sure there are other factors as well, but spending so much time standing can't be helping.

I'm glad that the Savella is helping you somewhat, and I certianly hope that it continues to do so.  I'm doing pretty alright on it so far.  I'm basically back to where I was a couple of months ago, before things starting getting real bad for me and I started having troube getting to work, so I call that progress.  I can live with my old baseline.  I just can't live with where it was headed.

Unfortunately, I had to get off the Savella(after only 4 months!).

  It was giving me Serotonin Syndrome(I think...rapid heart rate, sweating, incoherant,...) or it could have been tachycardia...I have a ventricular septal defect....I don't want to cause a life threatening problem, when all I have right now is pain.  Sad, but, those are the cards I'm dealt.  I will take the safe road.  Savella was really working for me too.  Back to Oxycontin, Flexeril, Vicodin and Aleve(for migraines), but, not too much since I have reflux and IBS.  Sigh.  I also, have some bulging discs, sciatica(from piriformis syndrome from several falls and old running injury), tennis elbow, arthritis in my neck, and so on.  But, nothing as bad as yours(Elizabeth G) god.  You have been through a lot!  I am a hair stylist and am on my feet for 6-8 hours a day....I can't imagine 12!  

Also, Fgetmenot: What is the "tyramine self imposed diet"????  Wellbutrin made me kinda crazy...fully sexual as well...but, it made me think everyone was a serial killer.  Not ok.  ;)  


Hope you all are having a good day! 

Oh and I agree Valium is amazingly effective.


Just got an update from the Med Watch newsletter.  New warning on the Savella packaging about  Serotonin Syndrome or Neuroleptic Malignant Syndrome (NMS)-Like Reactions.

Savella (milnacipran HCl) tablets

Detailed View: Safety Labeling Changes Approved By FDA Center for Drug Evaluation and Research (CDER) – February 2010




Serotonin Syndrome or Neuroleptic Malignant Syndrome (NMS)-Like Reactions
  • The development of a potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions have been reported with SNRIs and SSRIs alone, including Savella, but particularly with concomitant use of serotonergic drugs (including triptans), with drugs which impair metabolism of serotonin (including MAOIs) or with antipsychotics or other dopamine antagonists. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Serotonin syndrome, in its most severe form can resemble neuroleptic malignant syndrome, which includes hyperthermia, muscle rigidity, autonomic instability with possible rapid fluctuation of vital signs, and mental status changes. Patients should be monitored for the emergence of serotonin syndrome or NMS-like signs and symptoms.


my husband was just prescribed  savella for severe back pain or I should say shooting pains down the leg from a failed discetomy back in 2007.  He has been on Percoset/valuim and Lorazapam (for stress) he also had a spinal cord stimultor put in and still no relief.  I am hoping this new drug helps alleviate some of it.  The stimulator has been somewhat of a disappointment so far but its been 9 weeks.  I sometimes think he was hoping for more relief than he was getting...Its hard to watch him daily dealing with this pain.  I just worry about the side effects
ok... I am currently weening off Effexor (225mg) so my doc can start me on Savella.  She also has me on Adderall (20mg Xr in morning and 10mg in afternoon).  The Effexor had no real effects and when she increased the dosage to the 225mg I was having adverse seritonin symptom side effects. (acne, thoughts racing in all directions, forgetfullness,..)  I have not been able to find anyone who is only on Adderall and Savella to speak with to get an idea if the meds seem to be working ok together.  My doc said Savella is a fairly new treatment and she only has 2 patients on the meds so no real idea of the actual effects.  Anyone have any input on these 2 together??  Any info would be greatly appreciated! 

Elizabeth, If you could find a good Neromuscular Therapist in your area for regular treatments it could greatly extend the benefits of PT.  Try the ABMP or AMTA (professional organizations) for a referral to a local practitioner.


I have never been to this board & dont see any dates (I HATE THAT EVERYWHERE ON STUFF LIKE THIS!), but it came up as I was researching Savella & Adderall possibly causing serontonin syndrom. SAVELLA & ADDERALL ARE A NO NO!!!! From  amphetamines and other sympathomimetic appetite suppressants should not be combined with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Close monitoring for enhanced sympathomimetic together. effects and possible serotonin syndrome is recommended if these agents must be used

I have been on both without knowledge of this until now as my husband & I have been doing our research while I'm weaning off the hell of Savella!!! I've been taking 100mg Savella over 1 1/2 yrs, it worked for a little while, then evidently stopped at some point as I began having horrible FM flares. I decided after an ER incident to look into what all I was taking & start cutting back what wasn't needed or working. Savella was the#1 thing my doc wanted me to wean from because she said it was the hardest out of even Neurontin, Xanex, Valium & Lamictal! IT HAS BEEN HORRIBLE!!!  Docs are SO antsy about writing these prescriptions, but dont really look at the possible side effects & interactions! PLEASE BE VERY CAREFUL TO CHECK DRUG INTERACTIONS WITH EACH OTHER & SUPPLEMENTS!  Good luck... May God help us ALL!

Sorry for all the RED! LOL! I cut & pasted the warning & then everything I typed from there was red! LOL!

October 19, 2011

I breifly skimmed through some of the comments on this forum.  I began researching my severe SSRI with Cymbalta due to some poor communication with my psyciatrist.  This poor communication put me in a situation to be without the 120 mg per day of Cymbalta perscribed to me. The "discontinution symptoms" are EXTREMELY distressing and make me ill or worse. This "round" has been frightening.  I have had people ask me if I was diabetic due to my physical appearance while at the pharmacey trying to get my perscription. Cold sweats, "brain zaps", increased pulse (114-121), dizziness, feeling as though I were about to faint, had some behind the counter think I was about to go into a diabetic coma. 

I have been a  psychiatric patient for 40 years.  As time goes on, the diagnosis changes due to the research in mental health.  Which means medications and duration of those medications change as well.   For some reason I am only now realizing the SSRI issues that come with those medications.  

I am only going through with these comments in hopes that some of you will be VERY careful with the medications that WILL help your mental health issues.  As I mentioned earlier in this rambling post,  I was researching to find if there was a connection between how bad I feel and not having my medication.  

I finally came upon the "World Health Organization" and its finding on the serotonin uptake meds.  I was amazed at the information they provided.  Relieved and yet very concerned.  I have never had a psyciatrist .. a general practitioner..or a doctor of internal medicine STRESS the importance of not allowing a lapse of medication,  the SSRI that WOULD happen if the medication were changed or abruptly discontinued.

People with severe depression or bipolar disorder or any number of mental health issues MUST seek help. Your personal health and the emotional health of your loved ones depend on the proper help you seek.  But please be aware of the absolute necessity to open up complete communication channels with your doctor.

Maybe my rambling and inablility to spell, form complete thoughts and all the other inconsistent statement you see in the post  will show you what happens when you have a laspe in your meds.  

I hope that more information seekers will go to the WHO (World Health Org) web site and read, read, read.  BE INFORMED.   DON'T TURN AWAY FROM HELP BECAUSE OF THE SIDE EFFECTS!   Just Be Informed.  Be sure you NEVER EVER NEVER take 2 seritonin uptake inhibitors at one time.  ........

I am obviously pulled between the psyciatric help I must have and the outrage and anger I  feel because of how ill I am  because I am without my meds for a week.  It not only makes you sick, it can be dangerous.  What a Catch 22.

As for the rambling I keep mentioning.  The inability to concentrate for very long, if at all, about what message you are trying to get across.  This too is a sympton of SSRI.


I'm so happy to find others dealing with the effects of medications. I have had chronic back pain since 2004 following fusion surgery. I was recently on Lyrica, which only made me wish I wasn't alive to make others miserable. Cymbalta was added to the mix to balance my moods. (I also take a low dose of narcotics that have been altered recently). After nearly a year on both Lyrica & Cymbalta, I realized I couldn't keep up with all of the side effects any longer. Particularly the lack of compassion. I care for my mother with advanced Alzheimer's and last year my husband had a stroke. I also work full time in a demanding and stressful position. This all adds to depression and fatigue. So, doc and I decided to wean off of the Lyrica & Cymbalta and start Savella. I'm just doing the research on Savella, so haven't made the choice yet. I had a major breakdown over the last week while weaning. It's believed my seratonin level has dropped way low and my body hasn't begun producing it well enough yet. I've had outbursts that are scaring the daylights out of everyone (including the poor woman at Starbucks who "got into my personal space" I want to die alternating with living and hurting others. I feel like I'm going crazy. Anyway, I was hoping Savella might be the answer. Unfortunately, everything takes so stinking long to react that I'm hurting others while concocting the perfect relief. Thanks for your comments to assist in making my decision about Savella. Sometimes I think I'd rather just live with the pain.
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