• Sari Nakagawa, Yoshiaki Okamoto, Satoru Tsuneto, Hitoshi Tanimukai, Sho Goya, Yoichi Matsuda, Yumiko Oono, Mamiko Tsugane, and Etsuko Uejima.
• Department of Hospital Pharmacy Education, Graduate School of Pharmaceutical Science, Osaka University, Osaka, Japan. nakagawa@pharm.kobegakuin.ac.jp
• J Palliat Med. 2011 Apr 1; 14 (4): 403405403-5.

BackgroundMilnacipran is one of the classes of drugs that are serotonin and norepinephrine reuptake inhibitors (SNRIs). It is a promising drug for the treatment of neuropathic pain in patients with advanced cancer. However, we found that neuromuscular and somatosensory disorders occurred when milnacipran was used as an adjuvant analgesic.Case ReportA 66-year-old woman with a history of neuropathic pain was given 15 mg of milnacipran after dinner. The next morning she developed stiffness of the fingers, numbness in the mandible, and the soles of her feet felt swollen. Milnacipran was discontinued and her symptoms disappeared immediately. We managed this case, which was becoming severe, by discontinuing milnacipran on early detection of symptoms.DiscussionThis is the first report that demonstrates an adverse reaction of milnacipran when used as an analgesic adjuvant, and not as an antidepressant drug, for neuropathic pain in patients with advanced cancer. The analgesic effect of SNRIs will likely be used in the management of neuropathic pain in the future; however, clinicians should be aware of the early adverse reactions to these agents.

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