Lamegom (Agomelatine)

Agomelatine is indicated for major depressive disorder, a condition affecting mood, sleep and daily functioning.

• Major depressive disorder: reduces depressive symptoms and helps restore normal sleep‑wake cycles.

• Agomelatine binds to melatonin MT1 and MT2 receptors, acting as an agonist, while simultaneously blocking serotonin 5‑HT2C receptors. This dual activity synchronises circadian rhythms, enhances dopaminergic and noradrenergic transmission in the frontal cortex, and produces antidepressant effects without direct serotonergic reuptake inhibition.

Common Side Effects

• Headache: mild to moderate pain often occurring early in treatment.
• Nausea: transient stomach upset that usually resolves.
• Dizziness: sensation of light‑headedness, especially when standing quickly.
• Insomnia: difficulty falling or staying asleep.
• Fatigue: feeling unusually tired or low‑energy.
• 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.
• Severe allergic reactions: anaphylaxis or angioedema.
• QT prolongation: potential cardiac rhythm disturbances.
• Pancreatitis: inflammation of the pancreas, presenting with abdominal pain and vomiting.

Before initiating therapy, clinicians should assess liver function and monitor periodically throughout treatment.

• Liver monitoring: obtain baseline hepatic enzymes and repeat every 2–4 weeks.
• CYP1A2 inhibitors: avoid concomitant strong inhibitors such as fluvoxamine.
• Hepatic impairment: use with caution or avoid in patients with existing liver disease.
• Suicidal risk: regularly evaluate for worsening depression or suicidal thoughts.
• Pregnancy and lactation: prescribe only if benefits outweigh potential risks.
• Store at room temperature: keep in the original packaging, protect from moisture and direct sunlight.

Agomelatine may interact with several medicines that affect its metabolism or hepatic safety.

Major Interactions (Avoid)

• Strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin): can markedly increase agomelatine levels.
• Hepatotoxic drugs (e.g., isoniazid, methotrexate): add to liver injury risk.
• Oral contraceptives: may reduce agomelatine efficacy.

Moderate Interactions (Monitor Closely)

• CYP1A2 inducers (e.g., rifampicin, smoking): may lower drug exposure.
• Alcohol: can exacerbate liver toxicity.
• Other antidepressants with serotonergic activity: monitor for additive side effects.