Receiving Milnacipran, Venlafaxine, or Amitriptyline: Evidence from French Health Data

Milnacipran (Ixel in France, Savellain the US) is a selective serotonin and norepinephrine reuptake inhibitor (SNRI) that blocks the reuptake of norepi-nephrine in vitro approximately 3-fold more potently than that of serotonin.1,2 Other SNRIs, such as duloxetine and venlafaxine, preferentially block the re-uptake of serotonin.2 Amitriptyline, a tri-cyclic agent widely used clinically for depression, anxiety, and chronic pain conditions such as neuropathic pain and fibromyalgia,3 also inhibits reuptake of serotonin and norepinephrine in a ratio more similar to that of milnacipran than other SNRIs, such as duloxetine and venlafaxine.2 In addition, amitriptyline has demonstrated affinity for other re-ceptors in vitro.4,5 Venlafaxine and du-loxetine are approved by the Food and Drug Administration (FDA) for the treatment of major depressive disorder and general anxiety disorder. In the US, venlafaxine is also indicated for panic disorder and social anxiety disorder, and duloxetine is also approved for diabetic peripheral neuropathic pain and the man-agement of fibromyalgia. Milnacipran i