chemistry

Levomilnacipran

Levomilnacipran is a chemistry topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Levomilnacipran rather than just read about it. In short: Levomilnacipran ((1S,2R)-milnacipran), sold under the brand name Fetzima, is an antidepressant, used for the treatment of major depressive disorder in adults. It is the levorotatory enantiomer of milnacipran, and has similar effects and pharmacology, acting as a serotonin–norepinephrine reuptake inhibitor.

Key takeaways

Levomilnacipran belongs to chemistry; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Levomilnacipran to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Levomilnacipran from memory before moving on to harder problems.

Reference excerpt

Levomilnacipran ((1S,2R)-milnacipran), sold under the brand name Fetzima, is an antidepressant, used for the treatment of major depressive disorder in adults. It is the levorotatory enantiomer of milnacipran, and has similar effects and pharmacology, acting as a serotonin–norepinephrine reuptake inhibitor. Levomilnacipran was approved for medical use in the United States in July 2013.

Medical uses

Levomilnacipran is indicated for the treatment of major depressive disorder in adults.

Side effects Side effects seen more often with levomilnacipran than with placebo in clinical trials included nausea, dizziness, sweating, constipation, insomnia, increased heart rate and blood pressure, urinary hesitancy, erectile dysfunction and delayed ejaculation in males, vomiting, tachycardia, and palpitations.

Pharmacology

Pharmacodynamics Relative to other serotonin and norepinephrine reuptake inhibitors, levomilnacipran, as well as milnacipran, differ in that they are much more balanced reuptake inhibitors of serotonin and norepinephrine. 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. The clinical implications of more balanced elevations of serotonin and norepinephrine are unclear, but may include improved effectiveness, though also increased side effects. Levomilnacipran is selective for the serotonin and norepinephrine transporters, lacking significant affinity for over 23 off-target sites. However, it does show some affinity for the dizocilpine (MK-801/PCPTooltip phencyclidine) site of the NMDA receptor (Ki = 1.7 μM), and has been found to inhibit NR2A and NR2B subunit-containing NMDA receptors with respective IC50 values of 5.62 and 4.57 μM. As such, levomilnacipran is an NMDA receptor antagonist at high concentrations.

Pharmacokinetics Levomilnacipran has a high oral bioavailability of 92% and a low plasma protein binding of 22%. It is metabolized in the liver by the cytochrome P450 enzyme CYP3A4, thereby making the medication susceptible to grapefruit-drug interactions. The drug has an elimination half-life of approximately 12 hours, allowing for once-daily administration. Levomilnacipran is excreted in urine.

History Levomilnacipran was developed by Forest Laboratories and Pierre Fabre Group, and was approved by the US Food and Drug Administration in July 2013. The FDA approved levomilnacipran for treating major depressive disorder. The approval was based on the results of five clinical trials. The trials included one 10-week phase II and four 8-week 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.

Research Levomilnacipran has been found to act as an inhibitor of beta-site amyloid precursor protein cleaving enzyme-1 (BACE-1), which is responsible for β-amyloid plaque formation, and hence may be a potentially useful drug in the treatment of Alzheimer's disease.

References

External links Media related to Levomilnacipran at Wikimedia Commons

Illustrations

Worked examples

Example 1 — a first encounter with Levomilnacipran

Start with the simplest possible case. Write down what Levomilnacipran claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In chemistry, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Levomilnacipran before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Levomilnacipran ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Levomilnacipran

In research: Levomilnacipran appears in chemistry research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Levomilnacipran in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Levomilnacipran is common in secondary-school and first-year university syllabi. It links to neighbouring topics Alzheimer's disease, Aminomethyl compounds, Carboxamides, so understanding it makes those chapters shorter.
In everyday life: Look for Levomilnacipran outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Levomilnacipran in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Levomilnacipran means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Levomilnacipran out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Levomilnacipran in simple terms?

Why does Levomilnacipran matter?

Because it connects several chemistry ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Levomilnacipran?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Levomilnacipran.