Lamegom (Agomelatine)

• Agomelatine acts on the melatonin and serotonin pathways to treat depressive disorders.
• Major depressive disorder: reduces depressive symptoms and improves mood in adult patients.
• Relapse prevention in depression: helps maintain remission after initial response.
• Sleep disturbances associated with depression: normalizes circadian rhythm and improves sleep quality.

• Agomelatine binds to melatonin MT1 and MT2 receptors, acting as an agonist, while simultaneously antagonizing serotonin 5‑HT2C receptors. This dual activity resynchronizes circadian rhythms and enhances dopaminergic and noradrenergic transmission in the frontal cortex, contributing to antidepressant effects without directly influencing monoamine reuptake. The drug’s effect on MT receptors promotes sleep onset, while 5‑HT2C blockade increases release of dopamine and norepinephrine, further supporting mood elevation.

Agomelatine may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Headache: mild to moderate pain often occurring early in treatment.
• Nausea: transient stomach upset.
• Dizziness: sensation of light‑headedness.
• Fatigue: feeling of tiredness or low energy.

Serious or Rare Side Effects

• Liver injury: elevated transaminases or hepatitis.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Suicidal thoughts: emergence or worsening of suicidal ideation.

When prescribing agomelatine, clinicians should observe several safety precautions to minimize risk.

• Liver function monitoring: assess hepatic enzymes before initiation and periodically during therapy.
• Avoid in severe hepatic impairment: contraindicated in patients with Child‑Pugh class C liver disease.
• Caution with suicidal ideation: monitor mood changes closely, especially at treatment start.
• Drug interaction caution: do not co‑administer strong CYP1A2 inhibitors such as fluvoxamine.
• Pregnancy and breastfeeding: use only if potential benefit justifies potential risk to fetus or infant.
• Store at ambient temperature: keep in original packaging, protect from moisture and light.

Agomelatine’s metabolism involves CYP1A2 and CYP2C9, leading to notable drug‑drug interactions.

Major Interactions (Avoid)

• Strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin): may markedly increase agomelatine plasma levels.
• CYP1A2 inducers (e.g., rifampicin, carbamazepine): may substantially reduce therapeutic effect.
• Concurrent serotonergic antidepressants (e.g., SSRIs, SNRIs): increase risk of serotonin syndrome.

Moderate Interactions (Monitor Closely)

• CYP2C9 substrates (e.g., warfarin, phenytoin): may require dose adjustment and INR monitoring.
• CYP2C19 inhibitors (e.g., omeprazole, fluoxetine): can modestly raise agomelatine concentrations.
• Alcohol consumption: may exacerbate potential hepatotoxicity, advise limited intake.