Cipran
Generic: Levomilnacipran Hydrochloride
Daily Dose:
Duration:
Cheaper & Alternative Brands (40 mg)
Same active generic (Levomilnacipran Hydrochloride), same form (Capsule (Extended Release)), exact same strength (40 mg)No other brands are currently registered in Bangladesh for the 40 mg presentation. Below are available brands for Levomilnacipran Hydrochloride in other strengths:
Clinical Prescribing Information
Medical monograph and safety information for healthcare professionals & patients.Indications & Clinical Uses
Cipran is a serotonin and norepinephrine reuptake inhibitor (SNRI) indicated for the treatment of Major Depressive Disorder (MDD) in adults.
Limitation of Use: Cipran is not approved for the management of fibromyalgia. The efficacy and safety of Cipran for the management of fibromyalgia have not been established.
Dosage & Administration
Recommended dose
: 40 mg to 120 mg once daily with or without food. Initiate dose at 20 mg once daily for 2 days and then increase to 40 mg once daily. Based on efficacy and tolerability, increase dose in increments of 40 mg at intervals of 2 or more days. The maximum recommended dose is 120 mg once daily. Take capsules whole; do not open, chew or crush.
Renal Impairment
: Do not exceed 80 mg once daily for moderate impairment. Do not exceed 40 mg once daily for severe renal impairment.
Discontinuation
: Reduce dose gradually whenever possible.
Contraindications
Hypersensitivity to levomilnacipran, milnacipran HCl or to any excipient in the formulation.
The use of MAOIs intended to treat psychiatric disorders with Levomilnacipran or within 7 days of stopping treatment with Levomilnacipran is contraindicated because of an increased risk of serotonin syndrome. The use of Levomilnacipran within 14 days of stopping an MAOI intended to treat psychiatric disorders is also contraindicated.
Starting Levomilnacipran in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome.
Side Effects & Adverse Reactions
Hypersensitivity
Suicidal Thoughts and Behaviors in Adolescents and Young Adults
Serotonin Syndrome
Elevated Blood Pressure
Elevated Heart Rate
Increased Risk of Bleeding
Angle Closure Glaucoma
Urinary Hesitation or Retention
Activation of Mania/Hypomania
Seizure
Discontinuation Syndrome
Hyponatremia
Pharmacology & Mechanism of Action
The exact mechanism of the antidepressant action of levomilnacipran is unknown, but is thought to be related to the potentiation of serotonin and norepinephrine in the central nervous system, through inhibition of reuptake at serotonin and norepinephrine transporters. Non-clinical studies have shown that levomilnacipran is a potent and selective serotonin and norepinephrine reuptake inhibitor (SNRI).
Levomilnacipran binds with high affinity to the human serotonin (5-HT) and norepinephrine (NE) transporters (Ki = 11 and 91 nM, respectively) and potently inhibits 5-HT and NE reuptake (IC50 = 16-19 and 11 nM, respectively). Levomilnacipran lacks significant affinity for any other receptors, ion channels or transporters tested in vitro, including serotonergic (5HT1-7), α- and β-adrenergic, muscarinic, or histaminergic receptors and Ca
2+
, Na
+
, K
+
or Cl
-
channels. Levomilnacipran did not inhibit monoamine oxidase (MAO).