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The compound appears to work by increasing intracellular NAD+ levels (through preventing nicotinamide consumption by NNMT), which activates sirtuins and enhances mitochondrial function and fatty acid oxidation, while also promoting a phenomenon called "browning" of white adipose tissue - the transformation of energy-storing white fat cells into metabolically active beige/brown adipocytes that burn fatty acids for thermogenesis rather than storing them

Patients should avoid self-sourcing it online and speak with a qualified provider before considering any longevity or metabolic compound

The starting dosage of milnacipran is 12.5 mg daily, and the agent may be slowly titrated up to 50 mg twice daily

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