Milran
Generic: Milnacipran Hydrochloride
Daily Dose:
Duration:
Alternatives (2)Cheaper & Alternative Brands
Same generic (Milnacipran Hydrochloride), same form (Tablet)
Clinical Prescribing Information
Medical monograph and safety information for healthcare professionals & patients.Indications & Clinical Uses
Milran tablet is indicated for the management of fibromyalgia. Milran is not approved for use in pediatric patients
Dosage & Administration
The recommended dose of Milnacipran HCI is 100 mg/day (50 mg twice daily). Based on efficacy and tolerability dosing may be titrated according to the following schedule:
Day 1
: 12.5 mg once
Days 2-3
: 25 mg/day (12.5 mg twice daily)
Days 4-7
: 50 mg/day (25 mg twice daily)
After Day 7
: 100 mg/day (50 mg twice daily).
Based on individual patient response, the dose may be increased to 200 mg/day (100 mg twice daily). Doses above 200 mg/day have not been studied.
Contraindications
Concomitant use of Milnacipran in patients taking monoamine oxidase inhibitors (MA01s) is contraindicated. In patients receiving a serotonin reuptake inhibitor in combination with a monoamine oxidase inhibitor (MAGI), there have been reports of serious, sometimes fatal, reactions including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma. In clinical trials, Milnacipran was associated with an increased risk of mydriasis. It should not be used Milnacipran in patients with uncontrolled narrow-angle glaucoma.
Side Effects & Adverse Reactions
The most frequently occuring adverse reactions were nausea, headache, constipation, dizziness, insomnia, hot flush, hyperhidrosis, vomiting, palpitations, heart rate increased, dry mouth and hypertensions.
Warnings & Precautions
Milran is a selective serotonin and norepinephrine re-uptake inhibitor (SNRI), similar to some drugs used for the treatment of depression and other psychiatric disorders. Patients both adult and pediatric, with depression or other psychiatric disorders may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking these medications, and this risk may persist until significant remission occurs. All patients being treated with drugs inhibiting the reuptake of norepinephrine and/or serotonin for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. The development of a potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions have been reported with SNRIs and SNRIs alone, including Milran, but particularly with concomitant use of serotonergic drugs (including triptans), with drugs which impair metabolism of serotonin (including MA01s) or with antipsychotics or other dopamine antagonists. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Milran have been associated with reports of increase in blood pressure.
Pharmacology & Mechanism of Action
Milnacipran is a potent inhibitor of neuronal norepinephrine and serotonin reuptake in approximately 1:3 ratio respectively. These actions simultaneously works synergistically to treat both depression and fibromyalgia and also improve multiple fibromyalgia symptoms such as peripheral and central pain, depressiveness, sleep and quality