Milnacipran

Savella
Milnacipran (trade names Ixel, Savella, Dalcipran, Toledomin) is a serotonin–norepinephrine reuptake inhibitor (SNRI) used in the clinical treatment of fibromyalgia.wikipedia
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Fibromyalgia

fibrositisFibromyalgia syndromemuscular rheumatism
Milnacipran (trade names Ixel, Savella, Dalcipran, Toledomin) is a serotonin–norepinephrine reuptake inhibitor (SNRI) used in the clinical treatment of fibromyalgia.
The medications duloxetine, milnacipran or pregabalin may be used.

Serotonin–norepinephrine reuptake inhibitor

SNRIserotonin-norepinephrine reuptake inhibitorSNRIs
Milnacipran (trade names Ixel, Savella, Dalcipran, Toledomin) is a serotonin–norepinephrine reuptake inhibitor (SNRI) used in the clinical treatment of fibromyalgia.
Milnacipran has a half-life of about 6 to 8 hours, and steady-state levels are reached within 36 to 48 hours.

Levomilnacipran

FetzimaLevo-milnacipran
Recently, levomilnacipran, the levorotatory enantiomer of milnacipran, has been found to act as an inhibitor of beta-site amyloid precursor protein cleaving enzyme-1 (BACE-1), which is responsible for β-amyloid plaque formation, and hence may be a potentially useful drug in the treatment of Alzheimer's disease.
It is the levorotatory enantiomer of milnacipran, and has similar effects and pharmacology, acting as a serotonin–norepinephrine reuptake inhibitor (SNRI).

Major depressive disorder

depressionclinical depressionmajor depression
It is not approved for the clinical treatment of major depressive disorder in the US, but it is in other countries.

Imipramine

imapramineTofranilimipramine pamoate
In a pooled analysis of 7 comparative trials with imipramine, milnacipran and imipramine were shown to have comparable efficacy while milnacipran was significantly better tolerated.

Tricyclic antidepressant

tricyclic antidepressantsTCAsTCA
However, compared with TCAs, significantly fewer patients taking milnacipran dropped out due to adverse events. The incidence of cardiovascular and anticholinergic side effects was significantly lower compared to TCAs as a controlled study with over 3,300 patients revealed.

Glycoside

glycosidescyanogenic glycosidescyanogenic glycoside

Norepinephrine

noradrenalinenoradrenergicnoradrenalin
Milnacipran inhibits the reuptake of serotonin and norepinephrine in an approximately 1:3 ratio, respectively.

Anticholinergic

anticholinergicsanticholinergic druganticholinergic syndrome
The incidence of cardiovascular and anticholinergic side effects was significantly lower compared to TCAs as a controlled study with over 3,300 patients revealed.

Liver function tests

liver enzymeliver function testliver enzymes
Elevation of liver enzymes without signs of symptomatic liver disease has been infrequent.

Mania

manicmanic episodemanic episodes
Mood swing to mania has also been seen and dictates termination of treatment.

Psychosis

psychoticpsychosespsychotic break
In psychotic patients emergence of delirium has been noticed.

Delirium

deliriousconfusionAcute confusional state
In psychotic patients emergence of delirium has been noticed.

Sedation

sedatedsedatingsedate
Milnacipran has a low incidence of sedation but improves sleep (both duration and quality) in depressed patients.

Sleep

sleepingsleep architectureasleep
Milnacipran has a low incidence of sedation but improves sleep (both duration and quality) in depressed patients.

Psychomotor agitation

agitationrestlessnessexcitement
In agitated patients or those with suicidal thoughts additive sedative/anxiolytic treatment is usually indicated.