[Clinical tolerance of a new antidepressant -- milnacipran].

Abstract

Milnacipran is a new antidepressant which has been developed for its selective inhibition of both serotonin and noradrenaline reuptake with a good safety and tolerability profile. The efficacy and tolerance profile of this antidepressant have been compared with those of tricyclic and selective serotonin reuptake inhibitor antidepressants (SSRIs) in open-label and placebo-controlled trials. But no data in clinical practice are available. The authors studied the tolerability of milnacipran (100 to 200 mg/d) in 28 depressed inpatients receiving usual comedications during a mean period of 33 days (3 to 107 days). The incidence of adverse events was determined with the help of the Pharmacovigilance Center of the Centre Hospitalo-Universitaire (Besançon, France). Among the 28 patients, milnacipran was well tolerated by 18 of them. Side-effects were noted in 10 patients, but they led to withdrawal of the antidepressant in only 2 cases, where dyspnea, palpitations, pollakiuria in a case and headache, nausea, dysuria in the other case occurred. The most frequent adverse event observed was hypotension (n = 6), but in each case it occurred just after the addition of sedative phenothiazines (n = 5) or of a comedication with phenothiazines and valpromide (n = 1). So this side-effect could not be attributed to milnacipran alone. Treatments with heptaminol or theodrenaline and cafedrine were useful. An increase of the cardiac frequency seemed to occur with milnacipran (p < 0.06). It was observed in the 5 inpatients for whom this cardiovascular parameter was recorded before and during the milnacipran treatment. In 5 other patients, the cardiac frequency seemed to decrease when milnacipran was stopped for lack of good efficacy or adverse events. Gastrointestinal disturbances were scarce isolated (nausea n = 1), but necessitated a treatment with metopimazine. The milnacipran prescription (100 mg/d) after an other antidepressant treatment had been done without a withdrawal period and without problem, even when the previous antidepressant was a SSRIs with a long half-life and CYP450 inhibitory properties. The authors concluded to the good tolerability of milnacipran in usual clinical practice.

• Authors: W Regina, P Vandel, S Vandel, D Sechter, P Bizouard
• Journal: L'Encephale (Encephale) 1999 May-Jun Vol. 25 Issue 3 Pg. 252-8 ISSN: 0013-7006 [Print] France
• Vernacular Title: Tolérance clinique d'un nouvel antidépresseur, le milnacipran.
• PMID: 10434151 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Chemical References

• Cyclopropanes
• Serotonin Uptake Inhibitors
• Vasodilator Agents
• cafedrine
• Phenylpropanolamine
• Heptaminol
• Theophylline
• Milnacipran

Topics

• Adult
• Aged
• Cardiovascular Diseases (chemically induced, prevention & control)
• Cyclopropanes (adverse effects)
• Depressive Disorder, Major (drug therapy, rehabilitation)
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Female
• Heptaminol (therapeutic use)
• Hospitalization
• Humans
• Hypotension (chemically induced)
• Male
• Middle Aged
• Milnacipran
• Phenylpropanolamine (analogs & derivatives, therapeutic use)
• Selective Serotonin Reuptake Inhibitors (adverse effects)
• Theophylline (analogs & derivatives, therapeutic use)
• Time Factors
• Treatment Outcome
• Vasodilator Agents (therapeutic use)