Milnacipran is a serotonin norepinephrine reuptake inhibitor (or SNRI for short). It is used for the treatment of fibromyalgia as well as major depressive disorder. In the United States, Milnacipran is not FDA approved for the treatment of major depressive disorder. It is approved in other countries. It is marketed under the brand name Savella as well as a few others.
Milnacipran works by inhibiting the reuptake of serotonin as well as norepinephrine in a respective ratio of 1:3. This means that the action taken upon both the neurotransmitters is somewhat balanced. The treatment of both fibromyalgia and depression can synergistically be treated when both of the neurotransmitters’ concentration is simultaneously increased.
After an oral dose, Milnacipran is absorbed well. It has a bioavailability of 85 percent. As such, it is not necessary to take the drug with food as food does not really affect the speed at which Milnacipran is absorbed. After the dose is taken, the drug peaks within two hours (its peak plasma concentration). Liver impairment and/or old age do nothing to increase the drug’s elimination half-life (which is eight hours). It is affected by renal disease.
Before being excreted in urine (as a conjugate and unchanged drug), Milnacipran is conjugated to the dormant glucuronide, leaving only slight traces of active metabolites.
Savella is used for the treatment of depression. In an investigation of a few qualified trials with Milnacipran and IMIPRAMINE were demonstrated to have equivalent effectiveness while Milnacipran was considerably better endured.
Another analysis comparing Milnacipran and a few SSRIs resulted in a principal efficacy for Milnacipran with analogous admissibility for Milnacipran and said SSRIs.
A later meta-analysis of six more studies including more than a thousand patients demonstrated no qualification in the middle of Milnacipran and SSRIs in effectiveness or discontinuation rates, including discontinuation for symptoms or lack of effectiveness.
Another meta-analysis of a total of sixteen randomized controlled trials with more than 2,200 patients inferred that there were no statistically significant differences in efficacy, acceptability and tolerability when comparing Milnacipran with other antidepressant agents. Be that as it may, compared with TCAs, significantly fewer patients taking Milnacipran dropped out of the trials because of adverse effects. As with different antidepressants, one to three weeks may elapse before significant antidepressant action turns out to be clinically apparent.
Amid its development for bromyalgia, Milnacipran was evaluated using a composite responder approach. To be considered as a responder for the composite treatment of bromyalgia endpoint, each patient had to indicate simultaneous and clinically meaningful changes in pain, physical capacity and global impression of disease status. A systematic survey in 2012 demonstrated moderate alleviation for a minority of individuals with fibromyalgia. Milnacipran was associated with increased adverse effects and stopping utilization of the medication.
The most common side effects of Milnacipran include headache, nausea, constipation, insomnia, dizziness, hot flashes, vomiting, hyperhidrosis, palpitations, increase in heart rate, hypertension and dry mouth. It is also possible for Milnacipran to adversely affect sexual function by decreasing one’s sexual ability and/or desire. It can cause testicular pain as well. On the plus-side, the chances of it causing anticholinergic and cardiovascular side effects are low when compared to TCAs.