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Contraindications and side effects of Milnacipran

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Discover the Contraindications and side effects of Milnacipran.

Although this drug is an antidepressant, it is also used against fibromyalgia.

This drug is not considered an antidepressant in the US.Contraindications and side effects of Milnacipran


There are a large number of antidepressants on the market, different substances having been synthesized to reduce or eliminate the typical symptoms of depressive episodes.

The different types interact at different levels and in different ways with one or more neurotransmitters, achieving more or less powerful effects and being more or less effective in certain cases.

Among the wide variety of these drugs that exist, in this article, we are going to talk about milnacipran, a very useful SNRI antidepressant.


What is milnacipran?

Milnacipran is a psychotropic drug made to combat depressive symptoms, be a drug that is part of the group of antidepressants.

Among them, it is classified as a specific serotonin and norepinephrine reuptake inhibitor or SNRI.

This drug is of great help in the treatment of problems such as passivity and lack of motivation and energy that many subjects with depression show, as well as in combating cognitive symptoms. It also allows improving the level of concentration and attention.

Although it is an approved drug used in much of the world, the truth is that it does not have the same approved indications in all countries, since authorities in different regions have considered that there is not enough data on its efficacy in specific disorders.

However, it is taken into account that it generates benefits in the treatment of both depression and other problems, the main one being fibromyalgia.

Mechanism of action of the drug

Milnacipran is an SNRI, a serotonin and norepinephrine reuptake inhibitor.


This means that its main mechanism of action is based on preventing presynaptic neurons from reabsorbing part of the neurotransmitters they have secreted (in this case, specifically serotonin and norepinephrine), so that said neurotransmitter remains available in space for longer. synaptic.

Thus, there are higher concentrations at the brain level of norepinephrine and serotonin.

A noteworthy aspect of milnacipran is that it has a greater action at the noradrenergic level than at the serotonergic level (in a ratio that some studies indicate is 3: 1), something uncommon in most antidepressants.

This characteristic is shared with another psychotropic drug, which has arisen from milnacipran and is its enantiomer (same chemical components, but rotated): levomilnacipran.

Disorders in which it is used

Milnacipran is a psychotropic drug whose properties make it useful in different disorders and pathologies.

The properties of this drug make it appropriate for the treatment of major depression, in which it has an efficacy similar to that of venlafaxine (another SNRI) or SSRIs.


It is especially useful in the treatment of subjects who present passivity and with little mobility and energy, being used in moderate and severe depressions.

It has also been applied to anxiety depressions and disorders such as generalized anxiety disorder.

Likewise, various studies have shown that milnacipran is also very useful in the treatment of medical problems associated with chronic pain, such as fibromyalgia.

This last disorder contributes to producing an improvement both in terms of reducing pain and that of the cognitive symptoms that usually accompany fibromyalgia.

It also seems to improve the mobility of the subjects who suffer from it.

Depending on the place

Interestingly, although we are dealing with a substance with antidepressant effects, its application in the treatment of the major depressive disorder is not approved in the United States.


In that country, milnacipran is approved only for the treatment of fibromyalgia.

On the other hand, in much of Europe (including Spain), milnacipran does not have a specific indication for fibromyalgia, but it is for depression.

Despite these differences, the truth is that those affected by both types of affection (which can also occur jointly) have presented an improvement in symptoms, being applied in clinical practice in both one and the other.

Side effects of Milnacipran

As with most drugs and psychotropic drugs, the use of milnacipran can be very useful for a large number of people, but can sometimes cause unpleasant side effects and even pose a risk for some people

Some of the most common side effects are hyperhidrosis or excessive sweating, nausea and vomiting, dizziness and hot flashes, blurred vision, constipation, urinary difficulties, or decreased libido.

Other more serious side effects are the possibility of tachycardias and hypertension, decreased levels of partner and liver problems. It has also been seen that in some severe cases it can cause seizures.


It has also been seen that in some people with bipolar disorder, it can lead to a manic episode, as well as exacerbating hallucinations and delusions in patients with psychotic disorders.

Although some studies seem to indicate that it is not frequent, it can also facilitate the appearance of suicidal thoughts.

Regarding contraindications, they should not take milnacipran pregnant or lactating, nor in minors.

It is contraindicated in people with heart problems (especially those who have recently suffered a heart attack) and kidney problems, as well as in narrow-angle glaucoma or urinary problems.

Finally, it is contraindicated if the subject follows treatment with MAOI antidepressants, as their combination could generate serotonin syndrome.


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