DEXTROMILNACIPRAN

Details

Stereochemistry	ABSOLUTE
Molecular Formula	C15H22N2O
Molecular Weight	246.348
Optical Activity	UNSPECIFIED
Defined Stereocenters	2 / 2
E/Z Centers	0
Charge	0

SHOW SMILES / InChI

Structure Search

SMILES

CCN(CC)C(=O)[C@@]1(C[C@@H]1CN)C2=CC=CC=C2

InChI

InChIKey=GJJFMKBJSRMPLA-HIFRSBDPSA-N

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+/m1/s1

HIDE SMILES / InChI

Description
Sources: https://www.ncbi.nlm.nih.gov/pubmed/23499664
Curator's Comment: https://www.tga.gov.au/sites/default/files/auspar-milnacipran-hydrochloride-120124.pdf

Dextromilnacipran (1R, 2S/F2696) is an enantiomer of milnacipran, a serotonin/norepinephrine (5-HT/NE) reuptake inhibitor. Dextromilnacipran is pharmacologically less active as compared with racemic mixture and levomilnacipran (1S, 2R/F2695).

CNS Activity

Originator

Approval Year

Targets

Primary Target	Pharmacology	Potency
Serotonin transporter 178 Target ID: CHEMBL228 Sources: https://www.ncbi.nlm.nih.gov/pubmed/23499664	Inhibitor 8297	290.0 nM [Ki]
Serotonin transporter 178 Target ID: CHEMBL228 Sources: https://www.ncbi.nlm.nih.gov/pubmed/23499664	Inhibitor 8297	16.9 nM [Ki]
Norepinephrine transporter 191 Target ID: CHEMBL222 Sources: https://www.ncbi.nlm.nih.gov/pubmed/23499664	Inhibitor 8297	139.0 nM [Ki]

Conditions

Condition	Modality	Targets	Highest Phase	Product
Fibromyalgia 89 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/022256s013lbl.pdf	Primary		Approved 8429	SAVELLA Approved Use Savella is indicated for the management of fibromyalgia. Savella is not approved for use in pediatric patients [see Use in Specific Populations (8.4) Launch Date 2009
Unknown 2578

C_max

Value	Dose	Co-administered	Analyte	Population
132 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/26663198/	50 mg single, oral dose: 50 mg route of administration: Oral experiment type: SINGLE co-administered:		MILNACIPRAN plasma	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
150 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/8923123/	50 mg single, oral dose: 50 mg route of administration: Oral experiment type: SINGLE co-administered:		MILNACIPRAN plasma	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN

AUC

Value	Dose	Co-administered	Analyte	Population
1316.9 ng × h/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/26663198/	50 mg single, oral dose: 50 mg route of administration: Oral experiment type: SINGLE co-administered:		MILNACIPRAN plasma	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN

T_1/2

Value	Dose	Analyte	Population
7 h EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/26663198/	50 mg single, oral dose: 50 mg route of administration: Oral experiment type: SINGLE co-administered:	MILNACIPRAN plasma	Homo sapiens population: HEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN
8 h EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/8923123/	50 mg single, oral dose: 50 mg route of administration: Oral experiment type: SINGLE co-administered:	MILNACIPRAN plasma	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN
6 h DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022256s023lbl.pdf	50 mg single, oral dose: 50 mg route of administration: Oral experiment type: SINGLE co-administered:	MILNACIPRAN plasma	Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: UNKNOWN

F_unbound

Value	Dose	Co-administered	Analyte	Population
87% EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/8923123/	50 mg single, oral dose: 50 mg route of administration: Oral experiment type: SINGLE co-administered:		MILNACIPRAN plasma	Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN
87% DRUG LABEL https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022256s023lbl.pdf	50 mg single, oral dose: 50 mg route of administration: Oral experiment type: SINGLE co-administered:		MILNACIPRAN plasma	Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: UNKNOWN

Doses

Dose	Population	Adverse events
100 mg 2 times / day multiple, oral Recommended Dose: 100 mg, 2 times / day Route: oral Route: multiple Dose: 100 mg, 2 times / day Sources: https://pubmed.ncbi.nlm.nih.gov/24188161 Page: p.593	unhealthy, 48.6 n = 181 Health Status: unhealthy Condition: Fibromyalgia Age Group: 48.6 Sex: M+F Population Size: 181 Sources: https://pubmed.ncbi.nlm.nih.gov/24188161 Page: p.593	Disc. AE: Nausea, Blood pressure increased... AEs leading to discontinuation/dose reduction: Nausea (2.4%) Blood pressure increased (1.4%) Heart rate increased (1%) Sources: https://pubmed.ncbi.nlm.nih.gov/24188161 Page: p.593
100 mg 2 times / day multiple, oral Recommended Dose: 100 mg, 2 times / day Route: oral Route: multiple Dose: 100 mg, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022256s011lbl.pdf Page: p.1	unhealthy Health Status: unhealthy Condition: Fibromyalgia Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022256s011lbl.pdf Page: p.1	Disc. AE: Suicidal ideation, Serotonin syndrome... AEs leading to discontinuation/dose reduction: Suicidal ideation Serotonin syndrome Neuroleptic malignant syndrome Blood pressure increased Heart rate increased Seizures Hepatotoxicity ALT increased (mild) Aspartate aminotransferase increase (mild) Hepatitis fulminant (rare) Bleeding Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022256s011lbl.pdf Page: p.1
100 mg 2 times / day multiple, oral Recommended Dose: 100 mg, 2 times / day Route: oral Route: multiple Dose: 100 mg, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022256s011lbl.pdf Page: p.11	unhealthy Health Status: unhealthy Condition: Fibromyalgia Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022256s011lbl.pdf Page: p.11	Disc. AE: Nausea, Palpitations... AEs leading to discontinuation/dose reduction: Nausea (6%) Palpitations (3%) Headache (2%) Constipation (1%) Heart rate increased (1%) Hyperhidrosis (1%) Vomiting (1%) Dizziness (1%) Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022256s011lbl.pdf Page: p.11
100 mg 2 times / day multiple, oral Recommended Dose: 100 mg, 2 times / day Route: oral Route: multiple Dose: 100 mg, 2 times / day Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022256s011lbl.pdf Page: p.5	unhealthy Health Status: unhealthy Condition: Fibromyalgia Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022256s011lbl.pdf Page: p.5	Disc. AE: Suicidal ideation... AEs leading to discontinuation/dose reduction: Suicidal ideation (1.3%) Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022256s011lbl.pdf Page: p.5

AEs

Overview

CYP3A4	CYP2C9	CYP2D6	hERG
inhibitor 1587 substrate 1737	inhibitor 1767 inducer 389	inhibitor 1852 substrate 1217	inhibitor 1612

OverviewOther

Other Inhibitor	Other Substrate	Other Inducer
CYP1A2 1524 CYP2A6 707 CYP2C19 1478 CYP2E1 882	P-gp 1537 CYP2C19 991 CYP1A2 1054	CYP1A2 701 CYP2B6 547 CYP2C8 168 CYP2C19 293 CYP3A4/5 124

Drug as perpetrator

Target	Modality	Activity
CYP1A2 1692	inducer 1573 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=27 Page: 27.0	no
CYP1A2 1692	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022256lbl.pdf#page=18 Page: 18.0	no
CYP2A6 739	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022256lbl.pdf#page=18 Page: 18.0	no
CYP2B6 1001	inducer 1573 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=27 Page: 27.0	no
CYP2C19 1553	inducer 1573 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=27 Page: 27.0	no
CYP2C19 1553	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022256lbl.pdf#page=18 Page: 18.0	no
CYP2C8 965	inducer 1573 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=27 Page: 27.0	no
CYP2C9 1819	inducer 1573 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=27 Page: 27.0	no
CYP2C9 1819	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022256lbl.pdf#page=18 Page: 18.0	no
CYP2D6 1891	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022256lbl.pdf#page=18 Page: 18.0	no
CYP2E1 970	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022256lbl.pdf#page=18 Page: 18.0	no
CYP3A4 1925	inhibitor 3277 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022256lbl.pdf#page=18 Page: 18.0	no
CYP3A4/5 335	inducer 1573 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=27 Page: 27.0	no

Drug as victim

Target	Modality	Activity	Clinical evidence
P-gp 1537	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=7 Page: 7.0	no
CYP2C19 991	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=55 Page: 55.0	no	no (co-administration study) Comment: no changes in PK of warfarin or milnacipran were observed Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=55 Page: 55.0
CYP1A2 1054	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=55 Page: 55.0	no	unlikely (co-administration study) Comment: when coadministered with carbamazepine, exposure (Cmax and AUC) to milnacipran decreased by 18% and 19%, respectively; Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=55 Page: 55.0
CYP2D6 1217	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=55 Page: 55.0	no	unlikely (co-administration study) Comment: At steady state, Cmax and AUC for milnacipran increased by only 10% and 20% when coadministered with levomepromazine; no changes in PK of warfarin or milnacipran were observed Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=55 Page: 55.0
CYP3A4 1737	substrate 3367 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=55 Page: 55.0	no	unlikely (co-administration study) Comment: when coadministered with carbamazepine, exposure (Cmax and AUC) to milnacipran decreased by 18% and 19%, respectively; Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_ClinPharmR_P1.pdf#page=55 Page: 55.0

Tox targets

Target	Modality	Activity	Metabolite	Clinical evidence
hERG 1647	inhibitor 1626 Sources: https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022256s000_PharmR_P2.pdf#page=59 Page: 59.0

Sourcing

Vendor/Aggregator	ID	URL
3B Scientific (Wuhan) Corp	3B2-6287	http://www.3bsc.com/index/pro_info.php?id=116365
AK Scientific, Inc. (AKSCI)	R211	http://www.aksci.com/item_detail.php?cat=R211
Acorn PharmaTech	ACN-035533	http://www.acornpharmatech.com/
Ambinter	Amb22801750	http://www.ambinter.com/reference/22801750
BLD Pharm	BD631023	http://www.bldpharm.com/products/92623-85-3.html
BLD Pharm	BD00756442	http://www.bldpharm.com/products/96847-55-1.html
BioCrick	BCC4194	http://www.biocrick.com/Milnacipran-BCC4194.html
CSNpharm	CSN18592	https://www.csnpharm.com/products/milnacipran.html
Chem Scene	CS-2009	http://www.chemscene.com/92623-85-3.html
ChemMol	99177637	http://www.chemmol.com/chemmol/99177637.html
ChemMol	99185159	http://www.chemmol.com/chemmol/99185159.html
Clearsynth	CS-P-00447	http://www.clearsynth.com/en/CSP00447.html
Hairui	HR143593	http://www.hairuichem.com/en/product/92623-85-3.html
Lab Network	LN01343162	https://labnetwork.com/frontend-app/p/#!/moleculedetails/LN01343162
MedChem Express	HY-B0168	https://www.medchemexpress.com/milnacipran.html
MuseChem	I012513	https://www.musechem.com/product/I012513.html
OChem	10310	http://www.ocheminc.com/index.php?act=psearch&pid=623M853
Sigma-Aldrich	CDS022174_ALDRICH	https://www.sigmaaldrich.com/catalog/product/aldrich/cds022174?utm_source=pubchem&utm_campaign=pubchem_2017&utm_medium=referral
Smolecule	S006221	http://www.smolecule.com/products/s006221
Smolecule	S535456	http://www.smolecule.com/products/s535456
THE BioTek	bt-255210	https://www.thebiotek.com/product/inhibitors/bt-255210
THE BioTek	bt-276385	https://www.thebiotek.com/product/inhibitors/bt-276385
iChemical	EBD2321826	http://www.ichemical.com/products/92623-85-3.html?utm_source=PubChem&utm_medium=website&utm_campaign=product%20catalogs

PubMed

Title	Date	PubMed
Which bioequivalence study for a racemic drug? Application to milnacipran.	1998 Apr-Jun	9725476
Idazoxan and 8-OH-DPAT modify the behavioral effects induced by either NA, or 5-HT, or dual NA/5-HT reuptake inhibition in the rat forced swimming test.	2001 Apr	11182533
[Pharmacokinetics and drug interactions of antidepressive agents].	2001 Aug	11519155
(1S,2R)-1-Phenyl-2-[(S)-1-aminopropyl]-N,N-diethylcyclopropanecarboxamide (PPDC), a new class of NMDA-receptor antagonist: molecular design by a novel conformational restriction strategy.	2001 Mar	11325012
Does combined treatment with novel antidepressants and a dopamine D3 receptor agonist reproduce cocaine discrimination in rats?	2001 Nov-Dec	11985331
High-performance liquid chromatographic method to screen and quantitate seven selective serotonin reuptake inhibitors in human serum.	2001 Sep 25	11587344
An investigation of monoamine receptors involved in antinociceptive effects of antidepressants.	2002 Jul	12088962
Remarkable effect of milnacipran in the treatment of Japanese major depressive patients.	2002 Jun	12404688
Pharmacology and pharmacokinetics of milnacipran.	2002 Jun	12369608
Differential effects of milnacipran and fluvoxamine, especially in patients with severe depression and agitated depression: a case-control study.	2002 Mar	11890186
Therapeutic effects of milnacipran, a serotonin and noradrenaline reuptake inhibitor, on post-stroke depression.	2002 May	11981353
In the rat forced swimming test, chronic but not subacute administration of dual 5-HT/NA antidepressant treatments may produce greater effects than selective drugs.	2002 Nov 15	12429415
Silent thyroiditis associated with short-term lithium therapy.	2002 Nov-Dec	12490351
The role of noradrenaline and selective noradrenaline reuptake inhibition in depression.	2002 Oct	12208564
A randomised, double-blind comparison of milnacipran and imipramine in the treatment of depression.	2002 Oct	12204314
Effect of chronic treatment with milnacipran on sleep architecture in rats compared with paroxetine and imipramine.	2002 Oct	12151030
Mechanism of action of antidepressants.	2002 Summer	12490828
[Psychotropic drugs used in a psychiatric hospital (pharmaco-epidemiologic aspects)].	2003	14681962
[Adverse effects of antidepressants and antimanics].	2003	12877003
Dual monoamine modulation for improved treatment of major depressive disorder.	2003 Feb	12544378
New hope in the treatment of painful symptoms in depression.	2003 Jan	12625027
Milnacipran plasma levels and antidepressant response in Japanese major depressive patients.	2003 Jun	12766929
Modulation of the human glucocorticoid receptor function by antidepressive compounds.	2003 May 22	12757900
Effect of pindolol and milnacipran versus milnacipran and placebo on plasma prolactin and adrenocorticotrophic hormone in depressed subjects.	2003 Oct	14533141
Efficacy of milnacipran for depressive symptoms in schizophrenia spectrum disorders.	2004 Apr	15009832
Post-treatment emergent adverse events in depressed patients following treatment with milnacipran and paroxetine.	2004 Dec	15570574
Reboxetine: a norepinephrine selective reuptake pump inhibitor.	2004 Jan	15334987
A case of temporo-mandibular disorder with fibromyalgia treated with the antidepressant, milnacipran.	2004 Jul	15252831
Subjective and polysomnographic effects of milnacipran on sleep in depressed patients.	2004 Jul	15252822
Efficacy of duloxetine, a potent and balanced serotonin-norepinephrine reuptake inhibitor in persistent pain models in rats.	2004 Nov	15254142
Remarkable effect of milnacipran, a serotonin-noradrenalin reuptake inhibitor (SNRI), on depressive symptoms in patients with Parkinson's disease who have insufficient response to selective serotonin reuptake inhibitors (SSRIs): two case reports.	2005 Feb	15694247
Anxiolytic-like effect of milnacipran in the four-plate test in mice: mechanism of action.	2005 Jul	15961146
Chronic treatment with milnacipran reverses the impairment of synaptic plasticity induced by conditioned fear stress.	2005 May	15619117
The effect of milnacipran (serotonin noradrenaline reuptake inhibitor) on memory in Korsakoff's syndrome after encephalitis.	2005 May-Jun	15882773

Patents

Sample Use Guides

In Vivo Use Guide

The recommended dose of Savella (Milnacipran) is 100 mg/day (50 mg twice daily). Based on efficacy and tolerability dosing may be titrated according to the following schedule: 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). Doses above 200 mg/day have not been studied.

Route of Administration: Oral

In Vitro Use Guide

Milnacipran inhibits norepinephrine and serotonin reuptake in rat hypothalamic synaptosomes with IC50 values of 30 and 150 nM, respectively

Name

Type

Language

DEXTROMILNACIPRAN

Common Name

English

F2696

Code

English

(1R,2S)-MILNACIPRAN

Common Name

English

F-2696

Code

English

CYCLOPROPANECARBOXAMIDE, 2-(AMINOMETHYL)-N,N-DIETHYL-1-PHENYL-, (1R-CIS)-

Systematic Name

English

CYCLOPROPANECARBOXAMIDE, 2-(AMINOMETHYL)-N,N-DIETHYL-1-PHENYL-, (1R,2S)-

Systematic Name

English

Code System Code Type Description

FDA UNII

ES1O38J3C4