When are Milnacipran and Levomilnacipran not recommended?

Milnacipran and Levomilnacipran are serotonin-norepinephrine reuptake inhibitors (SNRIs) primarily used in the treatment of fibromyalgia and major depressive disorder. Their pharmacokinetics and safety profile indicate that caution is warranted in specific populations.

In the case of end-stage renal disease, the clearance of these medications can be significantly impaired. The kidneys play a critical role in the excretion of the drug and its metabolites. In patients with severe renal impairment, including those with end-stage renal disease, the accumulation of the drug in the body can lead to increased risk of adverse effects and toxicity. Therefore, using Milnacipran and Levomilnacipran in this population is not recommended due to the potential for serious complications from accumulation and altered pharmacodynamics.

Options related to pregnancy, liver failure, and individuals under 18 years of age present different levels of concern but do not present the same acute risk of drug accumulation as in the case of end-stage renal disease. For instance, while these medications may have considerations in pregnancy and can potentially affect liver function, the most critical concern regarding safety and efficacy arises in the context of severely impaired renal function.