Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Milnacipran is a selective serotonin and
norepinephrine reuptake inhibitor (SNRI) used for treating pain associated with
fibromyalgia. It is similar to duloxetine (Cymbalta), venlafaxine (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 and
attach to receptors on the surface of nearby nerves or they attach to receptors
on the surface of the nerves that produced them, to be taken up by the nerve and
released again (a process referred to as re-uptake).
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 it also is thought to involve its
effects on serotonin and norepinephrine in the brain. Milnacipran was approved
by the FDA in January 2009.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 12.5, 25, 50, and 100 mg
STORAGE: Milnacipran should be stored at room temperature, 15- 30 C
(59-86 F).
PRESCRIBED FOR: Milnacipran is used for the treatment of pain associated with
fibromyalgia. In studies of adults (18-74 years old), milnacipran provided
better pain relief than placebo (sugar pill). Some patients may experience
relief as early as 1 week after treatment begins.
DOSING: The recommended dose is 50-100 mg twice daily. It may be
administered with or without food, but food improves the ability to tolerate
this medication.
DRUG INTERACTIONS: Milnacipran should not be used in combination with a
monoamine oxidase inhibitor (MAOI) such as phenelzine (Nardil), tranylcypromine
(Parnate), isocarboxazid (Marplan), and selegiline (Eldepryl), or within 14 days
of discontinuing the MAOI. At least 5 days should be allowed after stopping
milnacipran before starting an MAOI. Combinations of SNRIs and MAOIs may lead to
serious, sometimes fatal, reactions including very high body temperature,
rigidity, rapid fluctuations of heart rate and blood pressure, extreme agitation
progressing to delirium and coma. Similar reactions may occur if milnacipran is
combined with antipsychotics, tricyclic
antidepressants or other drugs that
affect serotonin in the brain [for example,
tryptophan and sumatriptan
(Imitrex)].
Combining milnacipran with epinephrine or norepinephrine may lead to
high
blood pressure and abnormal heart beats because milnacipran increases
epinephrine and norepinephrine.
Combining milnacipran with aspirin,
nonsteroidal antiinflammatory
drugs (NSAIDs), warfarin
(Coumadin) or other drugs that are
associated with bleeding may increase the risk of bleeding, because milnacipran
is associated with bleeding.
PREGNANCY: There are no adequate studies in pregnant women. Milnacipran
should be used during pregnancy only if the potential benefit justifies the
potential risk to the fetus.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Fibromyalgia causes pain, stiffness, and tenderness
of muscles, tendons, and joints without detectable inflammation.
Fibromyalgia does not cause body damage or deformity.
Fatigue occurs in 90% of patients with fibromyalgia.
Irritable bowel syndrome can occur with fibromyalgia.
Sleep disorder is common in patients with
fibromyalgia.
There is no test for the diagnosis of fibromyalgia.
Fibromyalgia can be associated with other rheumatic
conditions.
Fibromyalgia treatment is most effective with
combinations of education, stress reduction,
exercise, and medications.
What is fibromyalgia?
Fibromyalgia is a chronic condition that causes pain, stiffness, and tenderness of the muscles, tendons, and
joints. Fibromyalgia is also characterized by restless sleep, awakening feeling tired, chronic fatigue, anxiety...
Chronic Pain RSS
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