context: Fibromyalgia is a chronic condition. It can cause a range of troubling symptoms, from pain to fatigue. In the past, few options were available to manage this condition. Now, new medications such as Savella (milnacipran HCI) are providing renewed hope. Savella is the third medication approved to help manage fibromyalgia. Savella is a selective serotonin and norepinephrine reuptake inhibitor ( SNRI). It is similar to drugs used to treat depression and other psychiatric disorders. In January 2009, the FDA approved Savella to help manage fibromyalgia in adults. Available by prescription, it is the first drug introduced just for this purpose. Previous drugs approved to manage fibromyalgia include Lyrica (pregabalin), a nerve pain and epilepsy drug, and Cymbalta (duloxetine), another SNRI. With fibromyalgia, you may have a lower threshold for pain. Experts believe this may result from changes in your nervous system. These changes may cause you to be more sensitive to pain. This could result from the wrong levels of neurotransmitters. These are chemicals in your brain. Savella allows more of these neurotransmitters to travel from neuron to neuron. It is not exactly clear how Savella works. But increasing levels of neurotransmitters may ease pain and reduce fatigue or help with memory. However, not all these benefits have been tested in humans. Savella is a tablet. You take Savella in two divided doses each day. You start at 12.5 milligrams on the first day. Then you increase to 100 milligrams/day over a one-week period. Although the recommended dose is 100 milligrams/day, your doctor may increase it to 200 milligrams/day, based on your response to the medication. Your doctor may recommend the following regimen for taking Savella: Day 1: 12.5 milligrams once Days 2-3: 25 milligrams/day (12.5 milligrams twice daily) Days 4-7: 50 milligrams/day (25 milligrams twice daily) After Day 7: 100 milligrams/day (50 milligrams twice daily) Do not suddenly stop taking Savella. Clinical trials have reported improvements in twice as many of those taking Savella as those taking placebo. These improvements were reported in measurements of pain, fatigue and mental state. Before FDA approval, clinical trials of more than 2,000 patients reported improvements in many of those taking Savella. A larger number of patients using Savella than placebo had at least a 30% reduction in pain. They also rated their fibromyalgia either very much improved or much improved. In trials of Savella, the most common side effect was nausea. These are other common mild-to-moderate side effects of Savella: constipation dizziness insomnia hot flush or excessive sweating vomiting palpitations or increased heart rate dry mouth high blood pressure Have a conversation with your doctor before taking Savella. Discuss the risks and benefits of antidepressant medications. And have a clear understanding about your treatment choices. In rare cases, antidepressant medications may cause suicidal thoughts and actions. But this occurs mainly in children, teens, and young adults. If you or a loved one is taking Savella, watch for unusual changes in thought patterns or behavior. Do not take Savella if: You are taking or have recently taken another type of antidepressant called monoamine oxidase inhibitors ( MAOIs) You have an eye disease called narrow-angle glaucoma Before taking Savella, discuss with your doctor your use of other medications. This includes diuretics, triptans, or medications to treat psychiatric or neurological conditions. Ask if you should avoid nonsteroidal anti-inflammatory drugs ( NSAIDs), aspirin, or other drugs that thin blood. Combining these with Savella may increase your risk of abnormal bleeding. Also, before starting Savella, tell your doctor if you are nursing or pregnant or plan to become pregnant. And tell your doctor about any medical conditions you have, including: high blood pressure fast heart rate or other cardiac condition liver problems or a history of heavy alcohol use kidney problems history of mania or seizure disorders bleeding disorders Take these precautions while on Savella: Do not drive or use machinery until you are certain Savella is not affecting your mental or physical abilities. Avoid drinking alcohol. Talk with your doctor before stopping Savella and do not stop suddenly; this can cause withdrawal symptoms. Be sure to let your doctor know if you begin taking any other medications, including over-the-counter drugs.