BRAND NAMES
 MECHANISM OF ACTION
Agomelatine is a 5HT2c receptors antagonist localized on dopaminergic and noradrenergic nerve terminals. The blockade of this receptor increases noradrenaline and dopamine release in the synaptic space, specifically in the frontal cortex.
Treatment of major depressive episodes in adults
Adults: 25 mg once daily taken orally with or without food at bedtime. If there is no improvement of symptoms after two weeks of treatment, the dose may be increased to 50 mg once daily at bedtime. Patients should be treated for a sufficient period of at least 6 months.
- Hypersensitivity to Agomelatine
- Hepatic impairment (i.e. cirrhosis or active liver disease)
- Taking potent CYP1A2 inhibitors (e.g. fluvoxamine, ciprofloxacin)
- Increased serum transaminases have been observed in patients treated with agomelatine. Liver function tests should be performed in all patients at initiation of treatment and then periodically after around six weeks, twelve and twenty four weeks and thereafter when clinically indicated.
- Potent and moderate CYP1A2 inhibitors (fluvoxamine, ciprofloxacin and propranolol), inhibit the metabolism of Agomelatine resulting in a large increase in serum levels.
 PREGNANCY AND LACTATION
As a precautionary measure, it is preferable to avoid the use of Agomelatine during pregnancy. During lactation, If treatment with Agomelatine is considered necessary, breastfeeding should be discontinued.
 SIDE EFFECTS
The most common adverse reactions, usually transient, were: nausea, dizziness and headache.
Dose escalation was associated with an increase in liver function abnormalities.
 RELATED LINKS
|Tricyclic antidepressants||Amitriptyline (Elavil, Laroxyl) • Clomipramine (Anafranil) • Doxepin (Sinequan) • Imipramine (Tofranil) • Nortriptyline (Aventyl, Pamelor) • Trimipramine (Surmontil)|
|Selective serotonin reuptake inhibitors (SSRIs)||Citalopram (Celexa, Seropram) • Escitalopram (Cipralex, Lexapro) • Fluoxetine (Prozac) • Fluvoxamine (Luvox, Maveral) • Paroxetine (Paxil, Seroxat) • Sertraline (Zoloft)|
|Serotonin–norepinephrine reuptake inhibitors (SNRIs)||Desvenlafaxine (Pristiq) • Duloxetine (Cymbalta, Xeristar) • Venlafaxine (Efexor, Effexor)|
|Serotonin antagonists and reuptake inhibitors (SARIs)||Trazodone (Desyrel, Oleptro)|
|Norepinephrine reuptake inhibitors (NRIs)||Maprotiline (Ludiomil) • Reboxetine (Edronax)|
|Norepinephrine-dopamine reuptake inhibitors (NDRIs)||Bupropion (Wellbutrin)|
|Noradrenergic and specific serotonergic antidepressants (NaSSAs)||Mianserin (Lantanon) • Mirtazapine (Remeron)|
|Norepinephrine-dopamine disinhibitors (NDDIs)||Agomelatine (Valdoxan, Thymanax)|
|Monoamine oxidase inhibitors Nonselective||Tranylcypromine (Parnate)|
|Monoamine oxidase inhibitors B-Selective||Selegiline (Transdermal) (Emsam)|
|Others||5-Hydroxytryptophan • S-Adenosyl methionine • Hypericum (St John's wort)|