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Agomelatine: Effects, Dosage & Side Effects

Agomelatine is an antidepressant that regulates the sleep-wake cycle and is used in the treatment of major depressive episodes.

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Things worth knowing about "Agomelatine"

Agomelatine is an antidepressant that regulates the sleep-wake cycle and is used in the treatment of major depressive episodes.

What is Agomelatine?

Agomelatine is a next-generation antidepressant approved for the treatment of major depressive episodes (MDD) in adults. Marketed under the brand name Valdoxan, it differs significantly from classical antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants in its mechanism of action.

Mechanism of Action

Agomelatine acts on two distinct receptor systems in the brain:

Melatonin receptor agonist (MT1 and MT2): Agomelatine activates melatonin receptors in the hypothalamus, helping to regulate the circadian rhythm (the body's internal clock) and improving the sleep-wake cycle.
Serotonin 5-HT2C receptor antagonist: It simultaneously blocks specific serotonin receptors, leading to increased release of dopamine and noradrenaline in the frontal cortex. This effect contributes substantially to its mood-lifting properties.

Through this dual mechanism, agomelatine improves both mood and sleep quality without causing many of the side effects associated with other antidepressants, such as sexual dysfunction or weight gain.

Indications

Agomelatine is approved for the treatment of major depressive episodes in adults aged 18 years and older. It may be particularly beneficial for patients who:

Experience sleep disturbances associated with depression,
Do not respond adequately to other antidepressants,
Wish to avoid the sexual side effects commonly seen with SSRIs.

Dosage and Administration

The standard dose is 25 mg once daily, taken at bedtime. If there is insufficient response after two weeks, the dose may be increased to 50 mg per day. Tablets should always be taken at the same time each day, preferably just before going to sleep. Treatment should not be stopped abruptly; dosage should be tapered in consultation with a physician.

Side Effects

Agomelatine is generally well tolerated. The most common side effects include:

Headache
Dizziness
Nausea
Fatigue
Elevated liver enzyme levels (transaminases)

Particular attention must be given to hepatotoxicity: agomelatine can in rare cases cause liver damage. For this reason, regular liver function tests are mandatory (before starting therapy and after 3, 6, 12, and 24 weeks of treatment).

Contraindications and Interactions

Agomelatine must not be used in patients with:

Known hepatic impairment or elevated liver enzymes (more than three times the upper limit of normal),
Concomitant use of potent CYP1A2 inhibitors (e.g., fluvoxamine or ciprofloxacin), which strongly inhibit the metabolism of agomelatine and substantially increase its plasma concentration,
Children and adolescents under 18 years of age.

Alcohol consumption should be avoided during treatment with agomelatine, as it can increase the risk of liver toxicity.

Treatment Context

Agomelatine is used as monotherapy for mild to severe depression. The antidepressant effect typically becomes apparent after two to four weeks of treatment. A treatment duration of at least six months is recommended to prevent relapse. Therapy should always be conducted under medical supervision.

References

European Medicines Agency (EMA): Valdoxan (Agomelatine) - Product Information and Assessment Report. https://www.ema.europa.eu
Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 13th edition, McGraw-Hill Education, 2017.
Stahl SM: Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 4th edition, Cambridge University Press, 2013.

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