Drug General Information (ID: DDI08GPFZE)
Drug Name			Digitoxin		Drug Info		Milnacipran		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiarrhythmic Agents				Antidepressants
Structure

Mechanism of Digitoxin-Milnacipran Interaction (Severity Level: Moderate)
Additive hypertensive effects Click to Show/Hide Mechanism Graph
Drug Name		Digitoxin				Milnacipran
Mechanism		Hypertensive effects				Hypertensive effects
Key Mechanism Factor 1
		Factor Name		Hypertensive effects
		Factor Description		Hypertension is defined as a blood pressure reading above a prescribed limit (130/90 mmHg). Most people with hypertension have no signs or symptoms; others may experience: severe headache, shortness of breath, nosebleeds, severe anxiety, and feeling a tingling sensation in the neck or head.
Mechanism Description		Additive hypertensive effects by the combination of Digitoxin and Milnacipran

Recommended Action
Management		Coadministration of milnacipran and intravenous digoxin should be avoided. Caution is advised during coadministration with oral digoxin therapy. Blood pressure and heart rate should be measured prior to initiating milnacipran and periodically throughout treatment. A dosage reduction or discontinuation should be considered in patients who experience a sustained increase in blood pressure or heart rate while receiving milnacipran.

References
1	Product Information. Savella (milnacipran). Forest Pharmaceuticals, St. Louis, MO.