Lamegom (Agomelatine)

• Agomelatine is used to treat depressive disorders by targeting circadian rhythm dysregulation.
• Major depressive disorder: reduces depressive symptoms and improves overall mood in adult patients.
• Depressive episodes with sleep disturbances: helps normalize sleep patterns and mood regulation.

• Agomelatine acts as an agonist at melatonin MT1 and MT2 receptors while antagonising serotonin 5‑HT2C receptors. This dual activity resynchronises the circadian clock and enhances dopaminergic and noradrenergic neurotransmission in the frontal cortex, contributing to antidepressant effects.

Agomelatine may cause a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Headache: mild to moderate headache occurring early in treatment.
• Nausea: occasional feeling of nausea, usually transient.
• Dizziness: light‑headedness or vertigo reported by some patients.
• Insomnia: difficulty falling or staying asleep during initial weeks.

Serious or Rare Side Effects

• Elevated liver enzymes or hepatitis: significant increase in hepatic enzymes indicating possible liver injury.
• Severe skin reactions (e.g., Stevens‑Johnson syndrome): rare but potentially life‑threatening dermatologic events.
• Suicidal thoughts or behavior: emergence or worsening of suicidal ideation requiring immediate medical attention.

When prescribing agomelatine, several safety considerations should be observed.

• Liver function monitoring: assess hepatic enzymes before starting and periodically during therapy.
• Avoid in severe hepatic impairment: contraindicated in patients with significant liver disease.
• Caution with suicidal risk: monitor patients for emergence or worsening of suicidal thoughts.
• Drug interaction caution: do not co‑administer strong CYP1A2 inhibitors such as fluvoxamine.
• Alcohol consumption: limit alcohol intake as it may increase liver toxicity.
• Store at ambient temperature below 25°C: keep in the original pack, protect from moisture.

Agomelatine interacts with several medicines, requiring avoidance or careful monitoring.

Major Interactions (Avoid)

• Strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin, erythromycin): can markedly increase agomelatine plasma levels.
• Concomitant hepatotoxic drugs (e.g., isoniazid, methotrexate): raise risk of liver injury.
• Alcohol: combined use may exacerbate hepatic toxicity.

Moderate Interactions (Monitor Closely)

• CYP1A2 inducers (e.g., rifampicin, smoking): may reduce agomelatine efficacy.
• Other antidepressants (e.g., SSRIs, SNRIs): monitor for additive side effects.
• CNS depressants (e.g., benzodiazepines): may increase sedation.