The Canadian Agency for Drugs and Technologies in Health (CADTH) has issued a review of milnacipran for fibromyalgia. This agent is a serotonin norepinephrine reuptake inhibitor (SNRI) antidepressant, and preliminary evidence (‘methodologically weak’ Phase II and unpublished Phase III) suggests that it may benefit some patients with fibromylagia, although adverse effects may limit its use. Initial reports of longer term studies suggest that patient withdrawal from medication, seen in excess of 25% in Phase II studies, continues at a high rate. The agency concludes: “Based on the limited clinical trial results to date, it is unclear if milnacipran will provide an advantage over existing treatment in terms of efficacy or fewer adverse effects. It is also unclear how safe and effective milnacipran will be as an adjunct to existing treatments and in patients with co-morbid conditions”.
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