Uses of Neocipran: - Fibromyalgia - Depression Depression, Fibromyalgia Uncontrolled narrow-angle glaucoma. Concomitant use w/ MAOI or w/in 2 wk after withdrawal of MAOI.

Serotonin-norepinephrine reuptake inhibitor (SNRI)

Milnacipran is a potent inhibitor of neuronal norepinephrine and serotonin reuptake. It inhibits norepinephrine uptake with approx 3-fold higher potency in vitro than serotonin with directly affecting the uptake of dopamine or other neurotransmitters.

How to use Milnacipran Hydrochloride: Take this medicine in the dose and duration as advised by your doctor. Do not chew, crush or break it. Milnacipran Hydrochloride may be taken with or without food, but it is better to take it at a fixed time. Administration: Should be taken with food. Preferably taken during meals. Adult Dose: Oral Fibromyalgia Adult: 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). Depression Adult: 50 mg bid. Hepatic impairment Mild or moderate (Child-Pugh A or B): No dosage adjustment required Severe (Child-Pugh C): Caution advised Child Dose: <17 years: Safety and efficacy not established Renal Dose: Renal impairment Mild (CrCl 50-80 mL/min): No dosage adjustment required Moderate (CrCl 30-49 mL/min): Use with caution Severe (CrCl 5-29 mL/min): Reduce maintenance dosage by 50% (ie, to 50 mg/day divided q12hr) End-stage renal disease (ESRD): Use not recommended

Increased risk of bleeding w/ aspirin, NSAIDs, warfarin and other drugs that affect coagulation. Increased CNS effects w/ centrally-acting drugs (e.g. clomipramine). Increased risk of serotonin syndrome and NMS-like reactions w/ serotonergic drugs (e.g. tramadol), SSRIs, other selective serotonin-norepinephrine reuptake inhibitors, 5-HT1 receptor agonists (e.g. sumatriptan), antipsychotic agents and other dopamine antagonists. May inhibit antihypertensive effect of clonidine. May potentiate adverse haemodynamic effects w/ digoxin. Paroxysmal HTN and cardiac arrhythmia may occur when taken concurrently w/ epinephrine or norepinephrine. Potentially Fatal: Increased risk of serotonin syndrome and NMS-like reactions w/ MAOIs (e.g. linezolid, IV methylene blue).

Uncontrolled narrow-angle glaucoma. Concomitant use w/ MAOI or w/in 2 wk after withdrawal of MAOI.

Common - Nausea - Vomiting - Dizziness - Insomnia (difficulty in sleeping) - Constipation - Anxiety - Decreased appetite - Increased sweating - Sexual dysfunction >10% Nausea (37%),Headache (18%),Constipation (16%),Hot flush (12%),Insomnia (12%) 1-10% (selected) Dizziness,Hyperhidrosis,Hypertension,Migraine,Palpitations,Tachycardia,Vomiting,Xerostomia Frequency Not Defined Abnormal bleeding,Depression (worsening),Serotonin syndrome,Suicidal thoughts,Withdrawal signs or symptoms Potentially Fatal: Serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions, suicidal thinking/behaviour.

Pregnancy: Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during Milnacipran therapy. Patients should be encouraged to enroll in the Milnacipran Pregnancy Registry if they become pregnant, preferably before any prenatal testing is done. This registry is collecting information about the safety of milnacipran during pregnancy. Nursing: Advise patients to notify their physician if they are breast feeding

Precaution: Patient w/ major depressive disorder or other psychiatric disorders, history of dysuria, controlled narrow-angle glaucoma, pre-existing HTN, tachyarrhythmias or other CV disease, history of seizure disorder or condition predisposing to seizures (e.g. brain damage, alcoholism). Avoid abrupt withdrawal. Severe hepatic and moderate to severe renal impairment including ESRD. Pregnancy and lactation. Lactation: Drug is excreted in human milk; peak breast milk concentration is observed within 4 hours after maternal dose, and estimated infant exposure is 5% of maternal dose; limited data are available regarding infant exposure, but caution is advised

Symptoms: Increased BP, cardio-resp arrest, changes in the level of consciousness (ranging from somnolence to coma), confusional state, dizziness, and increased hepatic enzymes. Management: Symptomatic treatment with gastric lavage and activated charcoal. Maintain adequate airway, oxygenation and ventilation and monitor cardiac rhythm and vital signs. May give cyproheptadine with adequate temp control to treat serotonin syndrome.

Store at 25° C.

Serotonin-norepinephrine reuptake inhibitor (SNRI)

SNRI; has no affinity for other neurotransmitter receptors (including gamma-aminobutyric acid [GABA], beta-adrenergic, opiate, histaminergic, and benzodiazepine receptors) and has no MAOI activity.

Pregnancy: Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during Milnacipran therapy. Patients should be encouraged to enroll in the Milnacipran Pregnancy Registry if they become pregnant, preferably before any prenatal testing is done. This registry is collecting information about the safety of milnacipran during pregnancy. Nursing: Advise patients to notify their physician if they are breast feeding