What is milnacipran, and how does it work (mechanism of action)?

Milnacipran is a selective serotonin and
norepinephrine reuptake inhibitor (SNRI) used for treating pain associated with
It is similar to
duloxetine (Cymbalta),
(Effexor), and

desvenlafaxine (Pristiq). Milnacipran affects neurotransmitters, the
chemicals that nerves within the brain make and release in order to communicate
with one another. Neurotransmitters either travel across the space between
nerves, attach to receptors on the surface of nearby nerves or they attach to
receptors on the surface of the nerves that produced them. The neurotransmitters
may be taken up by the nerve and released again (a process referred to as

Serotonin and norepinephrine are two neurotransmitters released by nerves in
the brain. Milnacipran prevents the reuptake of serotonin and epinephrine by
nerves after they have been released. Since uptake is an important mechanism for
removing released neurotransmitters and terminating their actions on adjacent
nerves, the reduced uptake caused by milnacipran increases the effect of
serotonin and norepinephrine in the brain. The mechanism responsible for its
effectiveness for treating fibromyalgia is not known but milnacipran action is
thought to involve its effects on serotonin and norepinephrine in the brain.
Milnacipran was approved by the FDA in January 2009.

What brand names are available for milnacipran?


Is milnacipran available as a generic drug?


Do I need a prescription for milnacipran?


What are the side effects of milnacipran?

The most frequent side effects include: 

  • nausea,
  • headache,
  • constipation,
  • dizziness,
  • insomnia,
  • flushing,
  • excessive sweating,
  • vomiting,
  • palpitations,
  • increased heart rate,
  • dry mouth, and
  • high blood pressure.

Other side effects include: 

Antidepressants may increase the risk of suicidal thinking and behavior in children and adolescents with depression. Patients who are started on milnacipran or another antidepressant should be observed closely for clinical worsening, suicidal thinking and behavior, or unusual behavior.

Medically Reviewed by a Doctor on 5/15/2017

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