Milnacipran

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Milnacipran relieves chronic pain and depression

Milnacipran is the first in a new class of antidepressants known as

Norepinephrine Serotonin Reuptake Inhibitors (or NSRI's). It has

equal potency for inhibiting the reuptake of both serotonin and

noradrenaline. Extensive studies provide clear-cut evidence of its

efficacy in both severe and moderate depression in hospitalized and

community settings.

What makes Milnacipran different from the Selective Serotonin

Reuptake Inhibitors (SSRIs) – drugs like Prozac® – and Selective

Norepinephrine Reuptake Inhibitors (SNRIs) – drugs like Effexor – is

that Milnacipran affects two neurotransmitters, norepinephrine and

serotonin, almost equally (a 3:1 norepinephrine to serotonin

balance). In contrast a SNRI, tends to act much more on serotonin

than norepinephrine, (Effexor has a 1:30 norepinephrine to serotonin

ratio).

Since the 1990s, treatment for depression has relied upon the single

acting SSRIs, but in many ways, the SSRIs fall short. Most SSRIs have

unwelcome side effects, the most common being an increase in erectile

dysfunction and a decrease in libido (sex drive). Also, the vast body

of evidence shows that drugs that increase serotonin alone, or

norepinephrine alone, are equally effective in treating depression.

However, norepinephrine is clearly more important in treating pain.

Until recently, the most effective way to increase both

norepinephrine and serotonin was through administering a tricyclic

anti-depressants (TCAs).

TCAs affect 6 different targets, and as a consequence, they have

numerous side effects including dry mouth, weight gain, drowsiness,

fatigue, confusion, disorientation, cardiac abnormalities... Which is

why Milnacipran is a potential lifeline for so many people. It can

affect multiple pain mechanisms in a manner similar to that seen with

some tricyclic anti-depressants, but without the negative side

effects.

Trials involving 1032 patients show that Milnacipran provides

antidepressant efficacy similar to that of imipramine and

significantly superior to that of the SSRIs. Analysis of over 3300

patients shows that both the general and cardiovascular tolerability

of Milnacipran are superior to those of the TCAs with fewer

cholinergic side effects. The tolerability of Milnacipran was

comparable to that of the SSRIs, with a higher incidence of dysuria

with Milnacipran, and a higher frequency of nausea and anxiety with

the SSRIs.

As a result of this, and other, research, Milnacipran is now the new

therapeutic option for depression, offering clinical efficacy in the

range of the TCAs combined with a tolerability equivalent to that of

the SSRIs. In addition, Milnacipran is a promising treatment for

chronic pain conditions like Fibromyalgia and Lupus.

Fibromyalgia and Lupus

Fibromyalgia Syndrome (FMS) is a chronic pain syndrome that is

estimated to affect 2-4% of the general population. The symptoms of

FMS can be debilitating, and are characterized by chronic and

widespread pain throughout the body, often accompanied by severe

fatigue and poor sleep. Treatment options are limited as there are no

drugs specifically approved by the U.S. Food and Drug Administration

for the treatment of FMS. In tests, Milnacipran-treated patients

showed significant improvements in pain, fatigue and mood compared to

those who received a placebo.

Systemic Lupus Erythematosus (Lupus) is an autoimmune disease where

the body has turned on itself. In a Lupus sufferer, antibodies can

attack over 116 different types of their own proteins as if they were

foreign, dangerous viruses or bacteria. Trials using Milnacipran seem

to demonstrate a large degree of pain relief in sufferers plus a

general feeling of well-being.

Dosage:

Dosages for depression are usually in the order of 25mg to 50mg daily

(maximum 100mg).

Caution:

Like most anti-depressants there are contraindications with other

anti-depressants and MAO inhibiting drugs, including Gerovital-H3,

Deprenyl and Manerix, therefore combined use is not advised unless

under the guidance of a physician. Furthermore, we do not advise

combination with other Serotonin or Noradrenaline enhancing agents

such as Adrafinil, Modafinil, Paxil, Prozac®, Yohimbine and Zoloft

unless you are under the guidance of a physician.

New Support for Milnacipran as a Fibromyalgia Treatment

Monday December 8, 2008

NEWSBRIEF: A new Phase III clinical trial confirms earlier findings

that the drug milnacipran is an effective fibromyalgia (FMS)

treatment, according to Forest Laboratories. Forest, along with

Cypress Bioscience, is working to get milnacipran FDA approved for

FMS. It's currently not approved in the U.S. for any use.

Milnacipran is an NSRI (norepinephrine-serotonin reuptake

inhibbitor). It's used in more than 50 countries to treat depression.

Forest says this study once again showed that the drug is effective

at treating fibromyalgia pain. A full analysis of the study is due

out in a few weeks, the company says.

The FDA was expected to make a decision on milnacipran in October but

announced that it needed more time to review clinical data. At that

time, regulators said they expected to make a decision in a matter of

weeks but have not given a more specific timeline. To date, only

Lyrica (pregabalin) and Cymbalta (duloxetine) are FDA approved for

treating FMS

http://chronicfatigue.about.com/b/2008/12/08/new-support-for-

milnacipran-as-a-fibromyalgia-treatment.htm