Agomelatine


Concise Prescribing Info
Indications/Uses
Depression.
Dosage/Direction for Use
Adult : PO 25 mg once daily at bedtime, may increase to 50 mg after 2 wk, if needed.
Dosage Details
Oral
Depression
Adult: 25 mg once daily at bedtime, may be increased to 50 mg after 2 wk, if necessary.
Hepatic Impairment
Contraindicated.
Administration
May be taken with or without food.
Contraindications
Dementia. Elderly >75 yr. Hepatic impairment (i.e. active liver disease, cirrhosis) or serum transaminases >3 times upper limit of normal (ULN). Concomitant use w/ potent CYP1A2 inhibitors.
Special Precautions
Patient w/ bipolar disorder, mania, hypomania, DM, non-alcoholic fatty liver disease, pre-treatment elevated transaminases, history of suicide-related events or those who exhibit significant degree of suicidal ideation. Obese and alcoholic patients, smokers. Moderate to severe renal impairment.
Adverse Reactions
Significant: Suicidal thoughts and behaviour, increased liver enzymes, hepatitis, jaundice.
Nervous: Headache, migraine, insomnia, anxiety, delirium, tremor, aggression, agitation, nightmares, hallucinations, paraesthesia, restless leg syndrome, fatigue.
GI: Nausea, abdominal pain, dry mouth, dyspepsia, diarrhoea, constipation, vomiting.
Resp: Nasopharyngitis.
Musculoskeletal: Back pain.
Ophthalmologic: Blurred vision.
Dermatologic: Rash, pruritus, urticaria, eczema, hyperhidrosis.
Immunologic: Influenza.
Potentially Fatal: Hepatic failure.
Patient Counseling Information
This drug may cause dizziness or somnolence, if affected, do not drive or operate machinery.
MonitoringParameters
Perform LFT at baseline, before dose increase, at 3, 6, 12, 24 wk of treatment, then as clinically indicated. Monitor for signs/symptoms of hepatic injury (e.g. dark urine, light coloured stools, yellow skin/eyes, unexplained fatigue, pain in the upper right abdomen).
Overdosage
Symptoms: Epigastralgia, fatigue, agitation, somnolence, dizziness, anxiety, tension, malaise. Management: Symptomatic treatment.
Drug Interactions
Increased exposure w/ moderate CYP1A2 inhibitors (estrogen, enoxacin, propranolol). Decreased bioavailability w/ rifampicin.
Potentially Fatal: Potent CYP1A2 inhibitors (e.g. fluvoxamine, ciprofloxacin) may markedly increase agomelatine exposure.
Food Interaction
Avoid alcohol.
Action
Description: Agomelatine, a melatonin receptor (MT1 and MT2) agonist and serotonin (5-HT2C) antagonist, increases norepinephrine and dopamine release in the prefrontal cortex and has no influence on the extracellular levels of serotonin. It induces a phase advance of sleep, body temp decline, and melatonin onset. It has no effect on monoamine uptake and no affinity for α or β adrenergic, cholinergic, dopaminergic, histaminergic, and benzodiazepine receptors.
Pharmacokinetics:
Absorption: Rapidly and well absorbed. Absolute bioavailability: <5%. Time to peak plasma concentration: W/in 1-2 hr.
Distribution: Plasma protein binding: Approx 95%.
Metabolism: Rapidly metabolised in the liver, mainly by CYP1A2 enzyme, and to a lesser extent by CYP2C9 and CYP2C19 enzymes.
Excretion: Mainly via urine (80%, as inactive metabolites). Plasma half-life: 1-2 hr.
Chemical Structure

Click on icon to see table/diagram/image
Storage
Store below 30°C.
MIMS Class
ATC Classification
N06AX22 - agomelatine ; Belongs to the class of other antidepressants.
Disclaimer: This information is independently developed by MIMS based on Agomelatine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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