Milnacipran: Beyond a role of antidepressant

Chi Un Pae, David M. Marks, Manan Shah, Changsu Han, Byung Joo Ham, Ashwin A. Patkar, Prakash S. Masand

Research output: Contribution to journalReview articlepeer-review

37 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)355-363
Number of pages9
JournalClinical Neuropharmacology
Issue number6
Publication statusPublished - 2009 Nov


  • Antidepressant
  • Anxiety
  • Fatigue
  • Fibromyalgia
  • Milnacipran
  • Pain

ASJC Scopus subject areas

  • Pharmacology
  • Clinical Neurology
  • Pharmacology (medical)

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