[Clinical tolerance of a new antidepressant -- milnacipran].
Milnacipran is a new antidepressant which has been developed for its selective inhibition of both serotonin and noradrenaline reuptake with a good safety and tolerability profile. The efficacy and tolerance profile of this antidepressant have been compared with those of tricyclic and selective serotonin reuptake inhibitor antidepressants (SSRIs) in open-label and placebo-controlled trials. But no data in clinical practice are available. The authors studied the tolerability of milnacipran (100 to 200 mg/d) in 28 depressed inpatients receiving usual comedications during a mean period of 33 days (3 to 107 days). The incidence of adverse events was determined with the help of the Pharmacovigilance Center of the Centre Hospitalo-Universitaire (Besançon, France). Among the 28 patients, milnacipran was well tolerated by 18 of them. Side-effects were noted in 10 patients, but they led to withdrawal of the antidepressant in only 2 cases, where dyspnea, palpitations, pollakiuria in a case and headache, nausea, dysuria in the other case occurred. The most frequent adverse event observed was hypotension (n = 6), but in each case it occurred just after the addition of sedative phenothiazines (n = 5) or of a comedication with phenothiazines and valpromide (n = 1). So this side-effect could not be attributed to milnacipran alone. Treatments with heptaminol or theodrenaline and cafedrine were useful. An increase of the cardiac frequency seemed to occur with milnacipran (p < 0.06). It was observed in the 5 inpatients for whom this cardiovascular parameter was recorded before and during the milnacipran treatment. In 5 other patients, the cardiac frequency seemed to decrease when milnacipran was stopped for lack of good efficacy or adverse events. Gastrointestinal disturbances were scarce isolated (nausea n = 1), but necessitated a treatment with metopimazine. The milnacipran prescription (100 mg/d) after an other antidepressant treatment had been done without a withdrawal period and without problem, even when the previous antidepressant was a SSRIs with a long half-life and CYP450 inhibitory properties. The authors concluded to the good tolerability of milnacipran in usual clinical practice.
Regina
W
W
Service de Psychiatrie et Psychologie Médicale, CHU Saint-Jacques, Besançon.
Vandel
P
P
Vandel
S
S
Sechter
D
D
Bizouard
P
P
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000517:prevention & control; D003521:Cyclopropanes / Q000009:adverse effects*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000534:rehabilitation; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006535:Heptaminol / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D000078764:Milnacipran; D010665:Phenylpropanolamine / Q000031:analogs & derivatives / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013806:Theophylline / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D003521:Cyclopropanes; D006535:Heptaminol; D000078764:Milnacipran; D010665:Phenylpropanolamine; D017367:Selective Serotonin Reuptake Inhibitors; D013806:Theophylline; D014665:Vasodilator Agents; C002749:cafedrine
Tolérance clinique d'un nouvel antidépresseur, le milnacipran.