Lamegom (Agomelatine)

Agomelatine is used primarily in the management of depressive disorders, acting on circadian rhythm pathways.

• Major depressive disorder: reduces depressive symptoms and helps normalize sleep patterns.

• Agomelatine acts as an agonist at melatonin MT1 and MT2 receptors while antagonising serotonin 5‑HT2C receptors. This dual activity resynchronises disrupted circadian rhythms and modulates neurotransmitter release, contributing to antidepressant effects without directly influencing monoamine reuptake.

Adverse reactions reported with agomelatine vary in frequency and severity.

Common Side Effects

• Headache: mild to moderate pain often transient.
• Nausea: occasional stomach upset.
• Dizziness: sensation of light‑headedness.
• Insomnia: difficulty maintaining sleep.
• Fatigue: feeling unusually tired.
• Abdominal pain: mild discomfort in the stomach area.

Serious or Rare Side Effects

• Hepatotoxicity: elevated liver enzymes or liver injury requiring monitoring.
• Severe skin reactions: rash, Stevens‑Johnson syndrome, or toxic epidermal necrolysis.
• Suicidal thoughts: emergence or worsening of suicidal ideation.
• Anaphylaxis: rare severe allergic response.
• Elevated transaminases: significant rise in liver function tests.

When prescribing agomelatine, clinicians should consider several safety measures.

• Liver monitoring: perform baseline and periodic liver function tests.
• Hepatic impairment: avoid use in patients with severe liver disease.
• Suicidal risk: monitor patients for emergence of suicidal thoughts, especially early in therapy.
• CYP1A2 inhibitors: avoid concomitant strong inhibitors such as fluvoxamine.
• Pregnancy and lactation: assess risk‑benefit before use; limited data available.
• Store at room temperature: keep in the original pack, protect from moisture and direct sunlight.

Agomelatine may interact with other medicines through metabolic pathways.

Major Interactions (Avoid)

• Strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin, fluconazole): can markedly increase agomelatine plasma levels.
• Potent CYP2C9 inhibitors (e.g., amiodarone): may raise exposure.
• Hepatotoxic drugs (e.g., isoniazid): add to liver injury risk.

Moderate Interactions (Monitor Closely)

• CYP1A2 inducers (e.g., carbamazepine, smoking): may reduce efficacy.
• Other antidepressants (e.g., SSRIs, SNRIs): monitor for additive serotonergic effects.
• Oral contraceptives: may alter hormonal balance; observe clinical response.