Cataplexy is a sudden drop of antigravity-muscle tone triggered most often by positive emotional factors, which is one of the major symptoms of narcolepsy. Cataplexy has been treated pharmacologically, most often with tricyclic antidepressants. Even though tricyclic antidepressants are effective in reducing sleep paralysis and hypnagogic hallucinations, they even enhance daytime sleepiness, dizziness, and orthostatic hypotension. We assessed the anticataplectic effect of milnacipran, an SNRI, on human and canine narcolepsy. We also assessed the effect of milnacipran on REM sleep suppression in nocturnal sleep. Ten human patients with narcolepsy–cataplexy who changed medication from clomipramine to milnacipran due to side effects were enrolled. The change in the frequency of cataplexy and side effects before and after drug replacement was investigated. To assess milnacipran’s depressant effect on REM sleep, we performed nocturnal polysomnography examinations twice on each eight healthy adult subjects who were administered with milnacipran or placebo. In the study on canine narcolepsy, four genetically narcoleptic Doberman pinschers were enrolled. The food-elicited cataplexy test was used to assess the anticataplectic effect of milnacipran. Milnacipran significantly reduced cataplexy from 9.3 to 5.5 episodes per month in human patients without much side effects. The percentage of REM sleep significantly decreased ( p = 0.042) in the subjects with milnacipran (17.5 ± 1.7%) compared to subjects with placebo (21.5 ± 2.3%). Milnacipran also significantly reduced cataplexy dose-dependently in the study on canine narcolepsy. Milnacipran reduced cataplexy in human patients and REM sleep in healthy human subjects. Our study contributes further to previously reported role of adrenergic uptake inhibition in cataplexy. This compound had less side effect than those of tricyclic antidepressant, clomipramine.

中文翻译：

---

米那普仑（一种 SNRI）对人和犬发作性睡病的抗猝倒和 REM 抑制作用

猝倒是一种反重力肌肉张力突然下降，最常由积极的情绪因素触发，这是发作性睡病的主要症状之一。猝倒症已通过药物治疗，最常用的是三环类抗抑郁药。尽管三环类抗抑郁药可有效减少睡眠麻痹和入睡幻觉，但它们甚至会增强白天的嗜睡、头晕和体位性低血压。我们评估了米那普仑（一种 SNRI）对人和犬发作性睡病的抗猝倒作用。我们还评估了米那普仑对夜间睡眠中 REM 睡眠抑制的影响。招募了 10 名因副作用将药物从氯米帕明改为米那普仑的发作性睡病-猝倒患者。研究了药物替代前后猝倒频率和副作用的变化。为了评估米那普仑对 REM 睡眠的抑制作用，我们对每 8 名服用米那普仑或安慰剂的健康成人受试者进行了两次夜间多导睡眠图检查。在关于犬发作性睡病的研究中，招募了四只遗传性发作性睡病杜宾犬。食物诱发猝倒试验用于评估米那普仑的抗猝倒作用。米那普仑显着减少了人类患者的猝倒发作，从每月 9.3 次减少到 5.5 次，没有太多副作用。与安慰剂受试者 (21.5 ± 2.3%) 相比，米那普仑受试者 (17.5 ± 1.7%) 的 REM 睡眠百分比显着降低 (p = 0.042)。在犬发作性睡病的研究中，米那普仑还以剂量依赖性方式显着降低猝倒。米那普仑减少了人类患者的猝倒和健康人类受试者的 REM 睡眠。我们的研究进一步有助于先前报道的肾上腺素能摄取抑制在猝倒中的作用。该化合物的副作用比三环类抗抑郁药氯米帕明的副作用小。