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Milnacipran: uses and side effects of this drug

Milnacipran: uses and side effects of this drug

September 13, 2022

There are a lot of antidepressants in the market, having been synthesizing different substances in order to reduce or eliminate the typical symptomatology of depressive episodes.

The different types interact at different levels and in different ways with one or more neurotransmitters, achieving more or less powerful effects and being more or less effective in certain cases. Among the great variety of these drugs that exist, in this article Let's talk about milnacipran, a very useful antidepressant IRSN .

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What is the milnacipran?

Milnacipran is a psychopharmaceutical developed for the purpose of combating depressive symptoms, being a medically part of the group of antidepressants. Within them, it is classified as a specific inhibitor of the reuptake of serotonin and noradrenaline or IRSN.


This drug is of great help in the treatment of problems such as passivity and the lack of motivation and energy shown by many subjects with depression, as well as when it comes to combating cognitive symptoms. It also allows improving the level of concentration and attention.

Although it is a medicine approved and used in much of the world, it is certain that not all countries have the same approved indications, since the authorities of different regions have considered that there is not enough data on their efficacy in specific disorders. However, it does take into account that it generates benefits in the treatment of both depression and other problems , the main one being fibromyalgia.


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Mechanism of action of the drug

Milnacipran is an SNRI, an inhibitor of the reuptake of serotonin and noradrenaline. This means that its main mechanism of action is based on preventing the presynaptic neurons reabsorb part of the neurotransmitters that have secreted (in this case, specifically serotonin and noradrenaline), so that said neurotransmitter remains more available in the synaptic space. Thus, there are higher brain concentrations of noradrenaline and serotonin.

One aspect of milnacipran that stands out is that it presents a greater performance at noradrenergic level than serotonergic (in a relationship that some studies indicate is 3: 1), something uncommon in most antidepressants. This characteristic is shared with another psychopharmaceutical, which in fact has arisen from milnacipran and is its enantiomer (same chemical components, but rotated): the levomilnacipran .


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Disorders in which it is used

Milnacipran is a psychotropic drug whose properties make it useful in different disorders and pathologies. The properties of this drug make it suitable for the treatment of major depression, in which it has an efficacy similar to that of venlafaxine (another SNRI) or that of SSRIs. It is especially useful in the treatment of subjects who exhibit passivity and with little mobility and energy , used in moderate and severe depressions. It has also been applied to anxious depressions and to disorders such as generalized anxiety disorder.

Likewise, several studies have shown that milnacipran is also very useful in the treatment of medical problems that present with chronic pain, such as fibromyalgia. In the latter disorder, it contributes to an improvement both in reducing pain and in the cognitive symptoms that often accompany fibromyalgia. It also seems to improve the mobility of the subjects who suffer from it.

Depending on the place

Interestingly, although this is a substance with antidepressant effects, In the United States, its application in the treatment of major depressive disorder is not approved . In that country milnacipran is approved only for the treatment of fibromyalgia. On the other hand, in much of Europe (including Spain) milnacipran does not have specific indication for fibromyalgia, but in depression.

Despite these differences, the fact is that those affected by both types of condition (which can also occur jointly) have presented an improvement in the symptomatology, being applied in clinical practice both in one and in another.

Side effects and risks

As with most drugs and psychotropic drugs, the use of milnacipran can be very useful for a large number of people, but sometimes it can generate side effects unpleasant and even pose a risk to some people

Some of the most common side effects are hyperhidrosis or excessive sweating, nausea and vomiting, dizziness and hot flashes, blurred vision, constipation , urinary difficulties or decreased libido. Other more serious side effects are the possibility of tachycardia and hypertension, decreased partner levels and liver problems. It has also been seen that in some severe cases it can cause seizures.

It has also been seen that in some people with bipolar disorder, it can lead to a manic episode, as well as to exacerbate hallucinations and delusions in patients with psychotic disorders. Although some studies seem to indicate that it is not frequent, it can also facilitate the appearance of suicidal thoughts.

Regarding contraindications, should not take milnacipran pregnant or lactating , as well as in minors. It is contraindicated in people with heart problems (especially those who have suffered a heart attack recently) and kidney problems, as well as in narrow-angle glaucoma or urinary problems. Finally, it is contraindicated if the subject follows a treatment with MAOI antidepressants, since their combination could generate a serotonin syndrome.

Bibliographic references:

  • Cording, M .; Derry, S .; Phillips, T .; Moore, R. & Wiffen, P.J. (2015). Milnacipran for fibromyalgia in adults. Cochrane Database of Systematic Reviews, 10. Art. No .: CD008244. DOI: 10.1002 / 14651858.CD008244.pub3.
  • Montgomery, S. & Briley, M. (2010). Milnacipran: recent findings in depression. Neuropsychiatric Disease and Treatment, 6 (Suppl 1): 1-2.

Savella For Fibromyalgia & Warnings⚠ (September 2022).


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