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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Kyle, Jeffrey A. Dugan, B. Deeann Testerman, Kristian K. |
| Description | Country affiliation: United States Author Affiliation: Kyle JA ( Samford University, Birmingham, AL, USA. jakyle@samford.edu) |
| Abstract | OBJECTIVE: To review the pharmacology, pharmacokinetics, efficacy, and safety of milnacipran and evaluate relevant clinical trial data. DATA SOURCES: MEDLINE, International Pharmaceutical Abstracts, and Google Scholar searches (1966-June 2010) were conducted using the key words fibromyalgia, milnacipran, and serotonin-norepinephrine reuptake inhibitor. Searches were limited to articles published in English. STUDY SELECTION AND DATA EXTRACTION: All available English-language articles of human studies were evaluated. One pharmacokinetic study reviewed included animal data. References cited in identified articles were used for additional evaluation. DATA SYNTHESIS: Milnacipran is a serotonin-norepinephrine reuptake inhibitor with a 3-fold increased selectivity for norepinephrine compared to serotonin. It is well absorbed with 85-90% bioavailability. Maximum concentrations are achieved 2-4 hours after administration. Milnacipran does not undergo cytochrome P450 metabolism and has a half-life of 6-8 hours. Fifty-five percent of each dose is excreted unchanged in the urine. Dose adjustment is needed in patients with an estimated creatinine clearance of <30 mL/min. Clinical trials indicated that twice-daily dosing at 100 mg/day or 200 mg/day was superior to single-daily dosing. Studies further established the effectiveness of both doses in the treatment of fibromyalgia pain utilizing patient self-reported pain scores, as well as on a visual analog scale, Patient Global Impression of Change scale, and the Short-Form 36 Physical Component Summary. A 6-month extension trial, which evaluated patients continued on milnacipran for up to 1 year, demonstrated continued pain relief. The most common adverse drug reaction associated with milnacipran was nausea, which was reduced with slow-dose titration and administration with food. CONCLUSIONS: Milnacipran is an effective treatment option for patients with fibromyalgia. More head-to-head clinical trials are necessary to assess its ultimate place in therapy. |
| File Format | HTM / HTML |
| ISSN | 10600280 |
| Issue Number | 9 |
| Volume Number | 44 |
| e-ISSN | 15426270 |
| Journal | Annals of Pharmacotherapy |
| Language | English |
| Publisher | SAGE Publications |
| Publisher Date | 2010-09-01 |
| Publisher Place | United States |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Pharmaceutical Science Cyclopropanes Therapeutic Use Fibromyalgia Drug Therapy Serotonin Uptake Inhibitors Animals Pharmacokinetics Pharmacology Dose-response Relationship, Drug Humans Journal Article Review |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pharmacology (medical) |
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