This is a cause of obstructive shock, which presents as sustained low blood pressure, slowed heart rate, or pulselessness. Risk factors
About 90% of emboli are from proximal leg deep vein thrombosis (DVTs) or pelvic vein thromboses. The rare venous thoracic outlet syndrome can also be a cause of DVTs, especially in young men without significant risk factors. DVTs are at risk for dislodging and migrating to the lung circulation. The conditions are generally regarded as a continuum termed venous thromboembolism (VTE).VTE is much more common in immunocompromised individuals as well as individuals with comorbidities including:

Those that undergo orthopedic surgery at or below the hip without prophylaxis.This is due to immobility during or after the surgery, as well as venous damage during the surgery. Pancreatic and colon cancer patients (other forms of cancer also can be factors, but these are the most common)This is due to the release of procoagulants.Risk of VTE is at its greatest during diagnosis and treatment, but lowers in remission. Patients with high-grade tumors
Pregnant individualsAs the body puts itself into what is known as a "hypercoagulable state" the risk of a hemorrhage during childbirth is decreased and is regulated by increased expression of factors VII, VIII, X, Von Willebrand, and fibrinogen. Those on estrogen medicationThe development of thrombosis is classically due to a group of causes named Virchows triad (alterations in blood flow, factors in the vessel wall, and factors affecting the properties of the blood). Often, more than one risk factor is present.
The incidence of cardiovascular and anticholinergic side effects was significantly lower compared to TCAs as a controlled study with over 3,300 patients revealed. Elevation of liver enzymes without signs of symptomatic liver disease has been infrequent. Mood swing to mania has also been seen and dictates termination of treatment. In psychotic patients emergence of delirium has been noticed. Milnacipran has a low incidence of sedation but improves sleep (both duration and quality) in depressed patients. In agitated patients or those with suicidal thoughts additive sedative/anxiolytic treatment is usually indicated. Interactions
MAOIs — hyperserotonergia (serotonin syndrome), potentially lethal hypertensive crisis
5-HT1 receptor agonists — coronary vasoconstriction with risk of angina pectoris and myocardial infarction
Epinephrine, norepinephrine (also in local anesthesia) — hypertensive crisis and/or possible cardiac arrhythmia
Clonidine — antihypertensive action of clonidine may be antagonized
Digitalis — hemodynamic actions increased
Triptans — there have been rare postmarketing reports of hyperserotonergia (serotonin syndrome). If concomitant treatment of milnacipran with a triptan is clinically warranted, careful observation of patient is advised when starting or increasing dosages. Alcohol — no interactions known; however, because milnacipran can cause mild elevation of liver enzymes, caution is recommended; the FDA advises against the concomitant use of alcohol and milnacipran

Pharmacology
Pharmacodynamics
Milnacipran inhibits the reuptake of serotonin and norepinephrine in an approximately 1:3 ratio, respectively.