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The recommended dose of Milnacipran is 100 mg/day (50 mg twice daily). Based on efficacy and tolerability dosing may be titrated according to the following schedule:
Day 1: 12.5 mg once
Days 2: 25 mg/day (12.5 mg twice daily)
Days 4: 50 mg/day (25 mg twice daily)
After Day 7: 100 mg/day (50 mg twice daily)
Based on individual patient response, the dose may be increased to 200 mg/day (100 mg twice daily). Doses above 200 mg/day have not been studied.
Should be taken with food. Preferably taken during meals.
Renal Impairment: Severe (CrCl 59 mL/min): 25 mg bid, may increase to 50 mg bid according to response.
End stage renal disease (ESRD): Not recommended.
Pediatric use: Safety and effectiveness of Milnacipran in a fibromyalgia pediatric population below the age of 18 have not been established. The use of Milnacipran is not recommended in pediatric patients.
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