PsychRounds: The Psychiatry Podcast

[SNRI] - Milnacipran (Savella) & Levomilnacipran (Fetzima)

6 snips
Jan 26, 2024
Dive into the fascinating world of serotonin-norepinephrine reuptake inhibitors, focusing on Fetzima and Savella. Discover their unique properties, including the financial impact on patients and intriguing dosing strategies. The podcast explores their versatile applications in treating depression, anxiety, and neuropathic pain, while also unpacking their pharmacological complexities. A highlight is the discussion on the norepinephrine paradox in psychiatric treatment, emphasizing the need for deeper understanding in mental health therapies.
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INSIGHT

Balanced Noradrenergic-Serotonergic Ratio

  • Milnacipran (Savella) has a balanced noradrenergic to serotonergic effect ratio.
  • This makes it unique among SNRIs which often have different ratios.
INSIGHT

Levomilnacipran's Noradrenergic Dominance

  • Levomilnacipran (Fetzima) favors noradrenergic action about 2:1 over serotonergic.
  • This supports the heuristic that stronger noradrenergic SNRIs are used for pain treatment.
ADVICE

Dosing Guidelines for Milnacipran & Levomilnacipran

  • Start milnacipran with a titration pack moving from 12.5 mg daily to 50 mg BID.
  • Dose levomilnacipran once daily starting at 20 mg increasing to 40 mg, max 120 mg daily.
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