Here are excerpts from: Formulary; Feb2009, Vol. 44 Issue 2, p32-33, 3p about the newly FDA approved Milnacipran for fibromyalgia.  Please note the safety precautions.  There are some heavy duty concerns that should not be dismissed.  Please choose wisely.  Hope you are all doing as well as possible.

Selective noreplnephrine and serotonin
reuptal<e inhibitor approved for the
management of fibromyaigia

Milnacipran is a selective norepinephrine
and serotonin reuptake inhibitor that inhibits
norepinephrine uptake with greater
potency than serotonin uptake. The
precise mechanism by which this agent
inhibits pain and improves the symptoms
of fibromyaigia is unknown. Milnacipran
was approved on January 14, 2009, for
the management of fibromyaigia.

Milnacipran-treated patients
were also more likely to rate themselves
as much improved or very much improved
on the patient global assessment

Safety. Patients with depression or other
psychiatric disorders may experience worsening
of depression, suicidal ideation and
behavior, or unusual changes in behavior;
treatment with drugs that inhibit norepinephrine
and/or serotonin reuptake may play
a role in inducing these symptoms. Patients
treated with antidepressants should therefore
be monitored closely for changes in behavior,
especially early in treatment and at times of
dose changes. Treatment with drugs that
inhibit serotonin reuptake may lead to the development
of serotonin syndrome, especially
when these agents are used concomitantly
with serotonergic drugs and drugs that impair
the metabolism of serotonin. Inhibition
of norepinephrine and serotonin may lead to
cardiovascular effects, particularly increases
in blood pressure and heart rate. In clinical
trials, treatment with milnacipran was associated
with mild elevations of alanine aminotransferase
(ALT) or aspartate aminotransferase
(AST). Treatment with milnacipran
may lead to hyponatremia. Patients treated
with this agent may have an increased risk
of bleeding events. Milnacipran can affect
urethral resistance and micturition. Patients
treated with milnacipran have experienced
mydriasis; this agent should be used with
caution in patients with controlled narrowangle
glaucoma. The most common adverse
events associated with milnacipran treatment
include nausea, constipation, hot ñush, hyperhidrosis,
vomiting, palpitations, increased
heart rate, dry mouth, and hypertension.
Dosing. The recommended dose of mil