Lamegom (Agomelatine)

Agomelatine is indicated for the treatment of major depressive disorder in adult patients. By targeting melatonin and serotonergic pathways, it addresses mood symptoms and disrupted sleep‑wake cycles, offering a therapeutic option distinct from traditional antidepressants.

• Major depressive disorder: reduces depressive symptoms and helps normalize circadian rhythm.
• Maintenance therapy after remission: may support continued mood stability and regular sleep patterns.

• Agomelatine acts as an agonist at the MT1 and MT2 melatonin receptors, which resynchronises the circadian clock, and as an antagonist at the 5‑HT2C serotonin receptor, leading to increased dopaminergic and noradrenergic transmission in the frontal cortex. This combined action restores normal sleep‑wake cycles and modulates mood‑related neurotransmission, contributing to its antidepressant effect. The drug does not significantly inhibit monoamine reuptake, distinguishing it from many conventional antidepressants.

Agomelatine is generally well tolerated, but like all medicines it may cause adverse reactions.

Common Side Effects

• Headache: mild to moderate intensity.
• Nausea: transient gastrointestinal upset.
• Dizziness: may occur especially on standing.
• Insomnia: occasional difficulty falling asleep.
• Fatigue: feeling of tiredness during the day.
• Elevated liver enzymes: mild, usually reversible.

Serious or Rare Side Effects

• Hepatotoxicity: severe liver injury requiring monitoring.
• Severe skin reactions: such as Stevens‑Johnson syndrome.
• Suicidal thoughts: emergence of suicidal ideation.
• Allergic reactions: rash, angioedema, or anaphylaxis.
• QT prolongation: potential cardiac arrhythmia.
• Pancreatitis: inflammation of the pancreas.

When prescribing agomelatine, several safety considerations should be observed.

• Liver function monitoring: baseline and periodic liver enzyme tests are recommended.
• Alcohol consumption: avoid excessive alcohol as it may increase liver risk.
• Pregnancy and lactation: use only if benefits outweigh risks; data are limited.
• Concomitant CYP1A2 inhibitors: avoid or adjust dose as they can raise agomelatine levels.
• Driving and machinery: may cause dizziness; assess before operating.
• Store at ambient temperature: keep below 25 °C, in the original pack, protect from moisture.

Agomelatine can interact with other medicines, requiring attention to avoid adverse outcomes.

Major Interactions (Avoid)

• Strong CYP1A2 inhibitors (e.g., fluvoxamine, ciprofloxacin): can markedly increase plasma levels.
• Hepatotoxic drugs (e.g., isoniazid, valproate): raise risk of liver injury.
• Other serotonergic antidepressants: may increase risk of serotonin syndrome.

Moderate Interactions (Monitor Closely)

• CYP1A2 inducers (e.g., smoking, carbamazepine): may reduce efficacy.
• Oral contraceptives: may increase agomelatine exposure.
• Anticoagulants (e.g., warfarin): monitor INR as agomelatine may affect metabolism.