Lamegom (Agomelatine)

Agomelatine is used primarily in the treatment of depressive disorders, targeting mood regulation and sleep disturbances.

• Major depressive disorder (acute phase): alleviates depressive symptoms and improves sleep.
• Major depressive disorder (maintenance phase): helps prevent relapse and maintain mood stability.
• Adjunctive treatment of depression with circadian rhythm disruption: supports resynchronization of sleep‑wake cycles.

• Agomelatine acts as an agonist at melatonin MT1 and MT2 receptors, promoting circadian rhythm alignment, while simultaneously antagonizing serotonin 5‑HT2C receptors. This dual action enhances dopaminergic and noradrenergic neurotransmission in brain regions involved in mood regulation, contributing to antidepressant effects without directly influencing serotonin reuptake.

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 that usually resolves with continued use.
• Dizziness: sensation of light‑headedness, particularly when standing quickly.
• Fatigue: feeling of tiredness that may improve over time.

Serious or Rare Side Effects

• Liver injury: elevated liver enzymes or hepatitis requiring monitoring.
• Severe skin reactions: such as Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Suicidal thoughts: emergence or worsening of suicidal ideation, especially at treatment initiation.

Before initiating therapy, clinicians should evaluate hepatic function and consider patient‑specific risk factors.

• Liver monitoring: perform baseline and periodic liver function tests during treatment.
• Hepatic impairment: avoid use in patients with severe liver disease.
• CYP1A2 inhibitors: use caution when co‑administered with strong inhibitors, as exposure may increase.
• Pregnancy and lactation: safety not established; avoid unless benefits outweigh risks.
• Store at ambient temperature below 25°C: keep in the original pack, protect from moisture.

Agomelatine's metabolism and safety profile can be affected by concomitant medicines.

Major Interactions (Avoid)

• Strong CYP1A2 inhibitors (e.g., fluvoxamine): may cause toxic plasma levels.
• Hepatotoxic drugs (e.g., isoniazid): increase risk of liver injury.
• Combined use with other antidepressants that raise serotonin: potential for serotonin syndrome.

Moderate Interactions (Monitor Closely)

• CYP1A2 inducers (e.g., rifampicin, smoking): may reduce efficacy.
• Alcohol: can exacerbate liver toxicity.
• Caffeine: may modestly increase plasma concentrations.