Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Milnacipran(click to collapse)
1/4 selected
Milnacipran
Savella
Serotonin-Norepinephrine Reuptake Inhibitor
FDA-approved indications
- Fibromyalgia in adults ONLY
Off-label uses
- Depression (approved outside US; not FDA-approved for MDD in US)
- Chronic pain syndromes
- Chronic fatigue syndrome
MechanismBalanced SERT/NET inhibitor; FDA-approved ONLY for fibromyalgia, NOT depression
Half-lifed-milnacipran 8-10 hours, l-milnacipran 4-6 hours
Decision GuideWhen to pick each / when to consider an alternative
Milnacipran
Consider when
- Fibromyalgia with prominent fatigue — superior to duloxetine for fatigue reduction (Häuser 2010); NE-preferring profile may drive advantage
- Fibromyalgia patient on multiple medications — cleanest CYP profile of any SNRI (no CYP inhibition/induction; 13% protein binding)
- Fibromyalgia with hepatic impairment — no dose adjustment for mild-moderate; duloxetine is contraindicated in hepatic disease
- Fibromyalgia with comorbid depressive symptoms — SNRI antidepressant activity (approved for MDD in 30+ countries; not FDA-approved for MDD in US)
- +1 more
Consider an alternative when
- Pain severity is the primary target — duloxetine has superior pain SMD (−0.33 vs −0.17 at comparable doses; JAMA Netw Open 2022)
- Severe renal impairment (CrCl <30) — 55% excreted unchanged; requires 50% dose reduction; not recommended in ESRD
- Male patient with GU sensitivity — dysuria up to 7%, testicular pain, ejaculatory dysfunction; unique among SNRIs
- Uncontrolled hypertension or tachycardia — NE reuptake inhibition elevates BP/HR in 5–7%; requires baseline and periodic monitoring
- +1 more
| Axis | Milnacipran SNRI |
|---|---|
| Boxed Warnings | |
Suicidality (boxed warning) | |
| CNS | |
Headache | |
| Autonomic | |
Sweating | |
| Cardiac | |
Heart rate / tachycardia | |
| GI | |
Nausea / GI (general) | |
Constipation / GI hypomotility | |
| Discontinuation | |
Withdrawal / discontinuation | |
| Interactions | |
Serotonin syndrome risk | |