Talk:Milnacipran
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This barely-one-sentence-long entry isn't at all clear. It's a stub of some kind. Drug-related possibly. Needs help.
Structure
milnacipran shows chemical structure similarities with procaine.
79.21.31.44 (talk) 10:55, 2 March 2015 (UTC)
Editors might want to include this information -
Homicidal Ideation !! Milnacipran HCl(Savella)
"The Adverse Reactions section of the labeling for Savella was updated December 2012, to include aggression, anger and homicidal ideation." — Preceding unsigned comment added by 2601:648:4300:2A96:2568:408B:31D3:EB (talk) 10:30, 11 May 2018 (UTC)
Ratio of SERT:NET inhibition
See the first sentence in the Pharmacology/Pharmacodynamics section: "Milnacipran inhibits the reuptake of serotonin and norepinephrine in an approximately 1:3 ratio, respectively." This conflicts with the Wikipedia article on Levomilnacipran, where the equivalent section gives the SERT:NET inhibition ratio of milnacipram as 1.6:1 and that of levomilnacipram as 1:2. The relevant footnote in the Levomilnacipran article links to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008300, where the authors write, "Milnacipran is the most balanced reuptake inhibitor among the current SNRIs, with nearly equipotent reuptake inhibition of serotonin and norepinephrine. According to some sources, milnacipran may even have slightly more noradrenergic effects than serotonergic effects—up to threefold higher." The authors' reference to a 1:3 ratio as an extreme in a range of estimates is clearly not an endorsement. Later they write, "Unique among the SNRIs, levomilnacipran demonstrates a two-fold greater potency for norepinephrine reuptake inhibition in comparison to serotonin reuptake inhibition." Together with the first sentence in the previous excerpt, this shows that the authors believe levomilnacipran's 1:2 ratio is lower than that of milnacipran (i.e., that levomilnacipran's relative inhibition of NET is higher than that of milnacipran). Also see https://pubmed.ncbi.nlm.nih.gov/16142213, where eminent psychopharmacologist Stephen Stahl notes that "milnacipran blocks 5-HT and norepinephrine reuptake with equal affinity." I don't know where the 1.6:1 figure comes from, but it's is a lot closer to 1:1 than 1:3 is. Yeltommo (talk) 07:46, 9 March 2021 (UTC)
Tolerability?
The article describes similar tolerability as that of SSRIs (with reference to several studies). This contrasts with German patient reports, which imply the overall tolerability of Milnacipran were considerably worse when compared to the SSRI Sertraline:
Apart from the overall negative tendency, there is a case report of extreme heart rate increase induced by Milnacipran. 2003:D3:8741:DA00:1870:1643:98B4:23B3 (talk) 00:09, 13 February 2024 (UTC)
- Here's a study concerning the rare, severe heart effects:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233339/ 2003:D3:870C:B600:8922:20F3:E129:F47A (talk) 23:12, 16 February 2024 (UTC)