Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction

Interaction studies have only been performed in adults.
COMBINATIONS CONTRA-INDICATED:
With irreversible MAO inhibitors (iproniazid)
Risk of a serotonin syndrome (see section 4.4).
There should be an interval of two weeks between the end of treatment with a MAO inhibitor and the beginning of treatment with Milnacipran, and at least one week between the end of treatment with Milnacipran and the beginning of treatment with the MAO inhibitor.

Strict compliance with the dosage prescribed is an essential factor in preventing the onset of this syndrome.

With B Selective MAO inhibitors (selegiline)
Risk of paroxystic hypertension.
There should be an interval of two weeks between the end of treatment with a B selective-MAO inhibitor and the beginning of treatment with Milnacipran and at least one week between the end of treatment with Milnacipran and the beginning of treatment with B-MAO inhibitor.

With 5 HT1D agonists (sumatriptan, etc.)
By extrapolation with selective inhibitors of serotonin re-uptake.
Risk of hypertension and coronary artery vasoconstriction by additive serotoninergic effects.
Wait one week between the end of treatment with Milnacipran and the beginning of treatment with 5HT1D agonists.

With Digitalis (digoxin, etc.)
Risk of increased haemodynamic effects, in particular by parenteral route.

With alpha and beta sympathomimetics (IM and IV routes)

Paroxystic hypertension with possible arrhythmia (inhibition of entry epinephrine or norepinephrine into the sympathetic nerve fiber).

With Clonidine and related compounds
Inhibition of clonidine’s antihypertensive effect (antagonism with adrenergic receptors).

With A selective MAO inhibitors (linezolid, moclobemide, toloxatone, methylene blue) Risk of development of serotoninergic syndrome* (see section 4.4)
If this combination cannot be avoided, monitor patient very carefully. Initiate such a combination with the lowest recommended dose.

Adrenalin (gingival and subcutaneous routes)
Serious disorder of ventricular rhythm by increase of cardiac excitability.
Limit intake, for example, to less than 0.1 mg of adrenalin in 10 minutes or 0.3 mg in an hour, in adults.

ASSOCIATIONS REQUIRING PRECAUTIONS FOR USE:

With oral anticoagulants
Drugs which have an effect on platelet function, e.g. NSAIDs and aspirin, or other drugs that may increase the risk of bleeding

With Diuretics
Risk of hyponatraemia (see section 4.4)

Lithium
Risk of onset of serotonin syndrome* (see section 4.4). Perform regular clinical monitoring of the patient.