Successful treatment of trigeminal neuralgia with milnacipran.

Paroxysmal pain in a 64-year-old woman diagnosed with trigeminal neuralgia disappeared with the administration of carbamazepine, but carbamazepine had to be discontinued because of intolerable lassitude and liver dysfunction. Afterward, the paroxysmal pain reoccurred, and depressive symptoms appeared. Milnacipran was then administered at a dosage of 50 mg/d for 2 months, and the paroxysmal pain and depression disappeared completely. Carbamazepine is the drug of first choice for trigeminal neuralgia, but the present results suggest that milnacipran is worth investigating for patients who do not respond to carbamazepine, who cannot stay on carbamazepine because of side effects, and who exhibit depressive symptoms.