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Levomilnacipran: uses and side effects of this drug

Levomilnacipran: uses and side effects of this drug

August 17, 2022

Psychotropic drugs such as escitalopram, olanzapine or diazepam are relatively well known to the population, either by this name or by their different trademarks. These are different drugs that treat various disorders and alterations.

But even though these are some of the best known, they are not the only ones: new drugs have been continually being developed that combat the symptoms of different mental disorders. One of them, created and used in the treatment of depression, is the levomilnacipran .

  • Related article: "Types of antidepressants: characteristics and effects"

The levomilnacipran: type of substance

The levomilnacipran is a relatively recent antidepressant , being synthesized and approved its use in 2013. This substance is the enantiomer of milnacipran (something like the mirror image or the reflection in a mirror at the level of molecular organization, being easy to compare it with the differences between our left and right hands, which they have the same shape but different orientation), their molecules being rotated to the left.


This substance is a highly effective antidepressant that is part of the SNRIs or Specific Inhibitors of Reuptake of Serotonin and Noradrenaline . It fights the typical symptoms of depression such as anhedonia and sad mood, but is characterized especially by producing a great improvement in motivation and cognitive symptoms.

Thus, it contributes to improve concentration and energy level, making the apathy and passivity typical of many subjects suffering from depressive disorders difficult. On the contrary that many other psychotropic drugs, does not seem to generate relevant alterations with respect to the weight of those who take it.

  • Related article: "Psychotropic drugs: drugs that act on the brain"

Mechanism of action

As mentioned above, levomilnacipran is a specific inhibitor of the reuptake of serotonin and norepinephrine or SNRI. This implies that its main action at the neuronal level is as an agonist of serotonin and noradrenaline, increasing its levels by preventing these neurotransmitters from being reabsorbed by the neuron that emitted them and increasing the time they remain accessible in the synaptic space.


In addition, the mechanism of action of levomilnacipran has a remarkable feature: unlike most antidepressants, which focus on serotonin and may or may not affect secondarily or with less range to other neurotransmitters, levomilnacipran has a much greater effect on noradrenaline than on serotonin (approximately in a 2: 1 ratio, ie double). This action is what would generate an improvement at the level of energy, motivation, and capacity for concentration, making difficult the passivity that usually appears in depression.

  • Related article: "Types of neurotransmitters: functions and classification"

In what cases is it used?

Levomilnacepran is an antidepressant whose main indication is the treatment of major depression , being in this disorder especially effective in reducing emotional and cognitive symptoms. It is especially useful for those cases in which there is dysfunction and decreased socialization and reluctance and demotivation.


At the moment other uses have not been approved, although it is admitted that it can be effective in other problems. For example, research on its efficacy in cases of social phobia and chronic fatigue, as well as some anxiety disorders, may be useful. In some cases it has been used in subjects with bipolar disorder improving the situation of the subjects in the depressive phase, although there is a risk of exacerbating manic phases (with what is not recommended in these cases or at least it requires more research to the rest).

However, despite the fact that the medicine from which it is derived, the milnacepran, is used in the treatment of fibromyalgia, the levomilnacepran does not have such indication.

Side effects

Although very useful in the treatment of depression, the consumption of levomilnacipran has a series of possible side effects undesirable.

Generally, these side effects usually include nausea, vomiting, sweating, headache, tachycardia or irritability. Urinary problems such as difficulties with urination, typical symptoms of the common cold and sometimes (although not usual) erectile dysfunction or difficulties in ejaculation are also common. Hyper or hypotension, visual disturbances or weakness, insomnia and testicular pain may also appear.

In a much more serious way, One of the most relevant secondary symptoms is the possible appearance or increase of suicidal ideation , especially in the first moments and if it is a first use of antidepressants.

Hallucinations and seizures may also appear. Finally, although it occurs rarely and generally due to an interaction of this drug with other antidepressants or medications, one of the most serious risks is the possible appearance of a serotonin syndrome.

This syndrome is a serious condition in which fever, convulsions, alterations of consciousness that can lead to coma and even death can occur, making it especially important to monitor the dosage of the drug.

Contraindications

Levomilnacipran is a useful medicine, but for some people it could be a risk, which is why in some cases it is contraindicated.

They must take special care and ask if they can take it or not those people who present heart disease, hypertension, glaucoma, liver or kidney disease , urinary problems such as obstructions, seizures, hemophilia or coagulation problems or low levels of sodium in the body.

The consumption of levomilnacipran should be avoided if you suffer from allergy to this medication or if you are taking another antidepressant substance, especially in the case of MAOID antidepressants , due to the risk of serotonin syndrome. In the same way it should not be mixed with alcohol or other drugs. We must also take special care to avoid introducing methylene blue, a dye used in some medical tests and as an antiseptic in surgeries.

People with a history of suicide attempts should also not use this medication, as suicidal ideation may worsen. Regarding pregnant and lactating women , also have this medicine contraindicated. The use of this drug in patients with other mental disorders, such as bipolar disorder, should be discussed with the doctor.

Bibliographic references:

  • Asnis, G.M. & Henderson, M.A. (2015). Levomilnacipran for the treatment of major depressive disorder: a review. Neuropsychiatric Disease and Treatment, 11: 125-135.
  • Deardorff, W.J. & Grossberg, G.T. (2014). A review of the clinical efficacy, safety and tolerability of the antidepressants vilazodone, levomilnacipran and vortioxetine. Expert Opin. Pharmacother .; 15 (17): 2525-2542.

All About Serotonin & Norepinephrine Reuptake Inhibitors SNRIs Psychiatrist Robert D McMullen, MD (August 2022).


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