A once-a-day oral 
milnacipran modified release formulation has been developed. The formulation comprises an 
extended release dosage unit (optionally containing the 
immediate release portion) coated with delayed release 
coating. The 
milnacipran composition, when administered orally, first passes through the 
stomach releasing from zero to less than 10% of the total 
milnacipran dose and then enters the intestines where 
drug is released slowly over an extended period of time. The release profile is characterized by a 0.05-4 hours 
lag time period during which less than 10% of the total milnacipran 
dose is released followed by a slow or 
extended release of the remaining 
drug over a defined period of time. The composition provides 
in vivo drug plasma levels characterized by Tmax at 4-10 hours and an approximately linear drop-off thereafter and Cmax below 3000 ng / ml, preferably below 2000 ng / ml, and most preferably below 1000 ng / ml. The composition provides a 
therapeutic effect over approximately 24 hours, when administered to a patient in need, resulting in diminished incidence or decreased intensity of common milnacipran side effects such as sleep disturbance, 
nausea, 
vomiting, headache, tremulousness, 
anxiety, 
panic attacks, 
palpitations, 
urinary retention, orthostatic hypotension, 
diaphoresis, 
chest pain, 
rash, 
weight gain, 
back pain, 
constipation, vertigo, increased sweating, agitation, hot flushes, tremors, fatigue, 
somnolence, dyspepsia, dysoria, nervousness, 
dry mouth, 
abdominal pain, 
irritability, and 
insomnia.