Milnacipran
Summary
Milnacipran is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) used for the treatment of fibromyalgia and a short-term treatment of major depressive disorder.
Brand Names: Savella
Generic Name: Milnacipran
Background
Milnacipran is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) and like many agents in this category was originally developed for and continues to be approved and indicated for the treatment of depression 27,28,15,21. Furthermore, in 2009 the US FDA approved milnacipran for the additional indication of treating fibromyalgia 26, although other regional regulatory authorities like the EMA, among others, have not yet approved the agent for such treatment, citing lack of robust evidence of efficacy, insufficient demonstration of maintenance of effect, and other concerns 27,28. Nevertheless, milnacipran demonstrates a somewhat unique characteristic among SNRIs to elicit a relatively balanced reuptake inhibition of both serotonin and noradrenaline, with a somewhat increased preference for noradrenaline reuptake inhibition – which is potentially a point of interest given the plausible proposal that noradrenaline plays an important role in the mitigation of pain signals in the descending inhibitory pain pathways in the brain and spinal cord 14,18,19.
Moreover, recent research has shown that the levorotatory enantiomer of milnacipran, levomilnacipran, may have the capacity to inhibit the activity of beta-site amyloid precursor protein cleaving enzyme-1 (BACE-1), which has investigationally been associated with β-amyloid plaque formation – making the agent a possible course of treatment for Alzheimer’s disease 22.
Weight
Average: 246.354
Monoisotopic: 246.173213336
Chemical Formula: C15H22N2O