title: Milnacipran: beyond a role of antidepressant.
abstract: Milnacipran is a serotonin and norepinephrine reuptake inhibitor (SNRI) with negligible effects on any presynaptic or postsynaptic receptors. Milnacipran has unique pharmacokinetic and pharmacodynamic characteristics that distinguish it from the other marketed serotonin and norepinephrine reuptake inhibitors, venlafaxine, desvenlafaxine, and duloxetine such as equipotent serotonin and norepinephrine reuptake inhibition and a linear dose-concentration trend at therapeutic doses. The half-life of milnacipran is approximately 8 hours. In addition, milnacipran does not inhibit the cytochrome P 450 system, indicating minimal propensity for drug-drug interactions. The antidepressant efficacy of milnacipran has been clearly established in a number of randomized, double-blind, placebo-controlled clinical trials, and it has been widely used for treating major depressive disorder. Moreover, evidence suggests that milnacipran is effective and tolerable in the treatment of fibromyalgia and may have usefulness for fatigue and anxiety symptoms. The current paper reviews researches conducted to date that is relevant to the efficacy, tolerability, and mechanism of action of milnacipran in the treatment of depression, fibromyalgia, and other psychiatric syndromes. Future directions of research are also identified.
authors.affiliation: Department of Psychiatry, Holy Family Hospital, The Catholic University of Korea College of Medicine, Bucheon, Kyounggi-Do, Republic of Korea. pae@catholic.ac.kr
authors.forename: Chi-Un
authors.initials: CU
authors.lastname: Pae
authors.forename: David M
authors.initials: DM
authors.lastname: Marks
authors.forename: Manan
authors.initials: M
authors.lastname: Shah
authors.forename: Changsu
authors.initials: C
authors.lastname: Han
authors.forename: Byung-Joo
authors.initials: BJ
authors.lastname: Ham
authors.forename: Ashwin A
authors.initials: AA
authors.lastname: Patkar
authors.forename: Prakash S
authors.initials: PS
authors.lastname: Masand
mesh_terms: D000928:Antidepressive Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001007:Anxiety / Q000188:drug therapy; D003521:Cyclopropanes / Q000493:pharmacokinetics* / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D005221:Fatigue / Q000188:drug therapy; D005356:Fibromyalgia / Q000188:drug therapy; D006207:Half-Life; D006801:Humans; D000078764:Milnacipran; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000493:pharmacokinetics* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D003521:Cyclopropanes; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors