Levomilnacipran

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Levomilnacipran
Clinical data
Trade namesFetzima
AHFS/Drugs.comMonograph
Routes of
administration		By mouth (capsules)
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability92%[5]
Protein binding22%[6]
MetabolismHepatic (primarily by CYP3A4)[7]
Elimination half-life12 hours[7]
ExcretionKidney[7]
Identifiers
  • (1S,2R)-2-(Aminomethyl)-N,N-diethyl-1-phenylcyclopropanecarboxamide
JSmol)
  • CCN(CC)C(=O)[C@]1(C[C@H]1CN)C2=CC=CC=C2
  • InChI=1S/C15H22N2O/c1-3-17(4-2)14(18)15(10-13(15)11-16)12-8-6-5-7-9-12/h5-9,13H,3-4,10-11,16H2,1-2H3/t13-,15+/m0/s1 ☒N
  • Key:GJJFMKBJSRMPLA-DZGCQCFKSA-N ☒N
 ☒NcheckY (what is this?)  (verify)

Levomilnacipran (brand name Fetzima) is an

levorotatory enantiomer of milnacipran, and has similar effects and pharmacology, acting as a serotonin–norepinephrine reuptake inhibitor (SNRI).[8][9]

Medical uses

A bottle of Fetzima.

Depression

The FDA approved levomilnacipran for treating major depressive disorder. This approval was based on the results of five

phase III. Four of the five trials demonstrated a statistically significant superiority to placebo as measured by the Montgomery–Åsberg Depression Rating Scale. Superiority to placebo was also demonstrated by improvement in the Sheehan Disability Scale
.

Side effects

palpitations.[10][11]

Pharmacology

Pharmacodynamics

Relative to other SNRIs, levomilnacipran, as well as milnacipran, differ in that they are much more balanced reuptake inhibitors of serotonin and norepinephrine.[12][13][14] To demonstrate, the serotonin:norepinephrine ratios of SNRIs are as follows: venlafaxine = 30:1, duloxetine = 10:1, desvenlafaxine = 14:1, milnacipran = 1.6:1, and levomilnacipran = 1:2.[12] The clinical implications of more balanced elevations of serotonin and norepinephrine are unclear,[12] but may include improved effectiveness, though also increased side effects.[13][14][15]

Levomilnacipran is

NR2B subunit-containing NMDA receptors with respective IC50 values of 5.62 and 4.57 μM.[16] As such, levomilnacipran is an NMDA receptor antagonist at high concentrations.[16]

Levomilnacipran has recently been found to act as an

β-amyloid plaque formation, and hence may be a potentially useful drug in the treatment of Alzheimer's disease.[17]

Pharmacokinetics

Levomilnacipran has a high

elimination half-life of approximately 12 hours, allowing for once-daily administration.[7] Levomilnacipran is excreted in urine.[7]

History

Levomilnacipran was developed by

Pierre Fabre Group, and was approved by the Food and Drug Administration in July 2013.[10]

References

  1. FDA
    . Retrieved 22 Oct 2023.
  2. ^ Anvisa (2023-03-31). "RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial" [Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control] (in Brazilian Portuguese). Diário Oficial da União (published 2023-04-04). Archived from the original on 2023-08-03. Retrieved 2023-08-16.
  3. ^ "Product monograph brand safety updates". Health Canada. 7 July 2016. Retrieved 3 April 2024.
  4. ^ "Health Canada New Drug Authorizations: 2015 Highlights". Health Canada. 4 May 2016. Retrieved 7 April 2024.
  5. ^ a b c "Fetzima (levomilnacipran) Extended-Release Capsules, for Oral Use. Full Prescribing Information". Forest Pharmaceuticals, Inc. Subsidiary of Forest Laboratories, Inc. St. Louis, MO 63045 USA. July 2014. Retrieved 2 September 2016.
  6. ^
    ISBN 978-1-61537-122-8
    .
  7. ^
    ISBN 978-1-108-22874-9
    .
  8. ^ Myers C (22 December 2008). "Pierre Fabre Medicament and Forest Laboratories to Collaborate on Development and Commercialization of F2695 for Depression". FierceBiotech.
  9. S2CID 24621735
    .
  10. ^
    S2CID 205185145
    .
  11. PMID 24172209
    .
  12. ^
    PMID 24800132
    .
  13. ^
    S2CID 41502983
    .
  14. ^
    PMID 20856597
    .
  15. S2CID 36890464
    .
  16. ^
    S2CID 965954
    .
  17. PMID 25345508
    .

External links
Retrieved from "https://en.wikipedia.org/w/index.php?title=Levomilnacipran&oldid=1218181713"