What the FDA labels say about taking them together
Milnacipran and tramadol
Milnacipran's FDA label of September 10, 2025 names tramadol in its warnings and precautions section; tramadol's label does not name milnacipran itself but warns about its class (SNRIs (serotonin and norepinephrine reuptake inhibitors)). The milnacipran label: “The risk is increased with concomitant use of other serotonergic drugs and with drugs that impair metabolism of serotonin i.e., MAOIs.”
Check it at the source: the milnacipran FDA label on DailyMed (effective September 10, 2025, Allergan, Inc.); the tramadol FDA label on DailyMed (effective March 5, 2026, Lupin Pharmaceuticals, Inc.).
What does the milnacipran label say about tramadol?
Milnacipran label, warnings and precautionsThe risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, tramadol, meperidine, methadone, lithium, tryptophan, buspirone, amphetamines, and St. John’s Wort) and with drugs that impair metabolism of serotonin i.e., MAOIs [see Contraindications ( 4 ), Drug Interactions ( 7 )].
Source: FDA drug label (Savella), NDA022256 (Abbvie), as published by Allergan, Inc., effective September 10, 2025 (SPL set 16a4a314-f97e-4e91-95e9-576a3773d284), via openFDA; the full label on DailyMed
What does the tramadol label say about milnacipran?
Tramadol's label does not name milnacipran itself; it warns about its class (SNRIs (serotonin and norepinephrine reuptake inhibitors)):
Tramadol label, warnings and precautionsSyndrome with Concomitant Use of Serotonergic Drugs Cases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol products, including tramadol hydrochloride extended-release tablets, particularly during concomitant use with serotonergic drugs. Serotonergic drugs include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that …
Tramadol label, warnings and precautionsCases of serotonin syndrome, a potentially life-threatening condition, have been reported with the use of tramadol products, including Tramadol Hydrochloride Extended-Release Capsules, particularly during concomitant use with serotonergic drugs. Serotonergic drugs include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), triptans, 5-HT3 receptor antagonists, drugs that affect the serotonergic neurotransmitter system (e.g. …
Source: FDA drug label (TRAMADOL HYDROCHLORIDE), Lupin Pharmaceuticals, Inc., effective March 5, 2026 (SPL set 46bb9ae6-3ee8-463c-badb-c7a45a89b84b), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Milnacipran | Tramadol | |
|---|---|---|
| Labeled for | Nerve pain and fibromyalgia | Pain |
| Boxed warning | Yes | Yes |
| Pharmacy cost (NADAC) | $2.82 per tablet 100 mg tablet | $0.0248 per tablet 50 mg tablet |
| Shortage now | No current entry | No current entry |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once