Drug reference
A melatonin receptor agonist and a selective serotonin-receptor antagonist; it does not affect the uptake of serotonin, noradrenaline, or dopamine. MAOIs inhibit monoamine oxidase, thereby causing an accumulation of amine neurotransmitters.
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Major depression ▶BY MOUTH ▶Adult: 25 mg daily, dose to be taken at bedtime, dose to be increased if necessary after 2 weeks, increased if necessary to 50 mg daily, dose to be taken at bedtime
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Dementia. patients over 75 years of age Cerebrovascular disease. not indicated in manic phase. phaeochromocytoma. severe cardiovascular disease
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Alcoholism. bipolar disorder. diabetes. excessive alcohol consumption. hypomania. mania. non- alcoholic fatty liver disease. obesity Acute porphyrias p. 1120. avoid in agitated patients. blood disorders. cardiovascular disease. concurrent electroconvulsive therapy. diabetes mellitus. elderly (great caution). epilepsy. severe hypertensive reactions to certain drugs and foods. surgery
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→Appendix 1: agomelatine
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▶Common or very common Abdominal pain. anxiety. back pain. constipation. diarrhoea. dizziness. drowsiness. fatigue. headaches. nausea. sleep disorders. vomiting. weight changes ▶Uncommon Aggression. confusion. hyperhidrosis. mood altered. movement disorders. paraesthesia. skin reactions . suicidal tendencies. tinnitus. vision blurred ▶Rare or very rare Angioedema. face oedema. hallucination . hepatic disorders. urinary retention SIDE-EFFECTS, FURTHER INFORMATION The use of antidepressants has been linked with suicidal thoughts and behaviour; children, young adults, and patients with a history of suicidal behaviour are particularly at risk. Where necessary patients should be monitored for suicidal behaviour, self-harm, or hostility, particularly at the beginning of treatment or if the dose is changed. Akathisia. anxiety. appetite increased. arrhythmia. asthenia. behaviour abnormal. blood disorder. confusion. constipation. dizziness. drowsiness. dry mouth. dysuria. hallucination. headache. hyperhidrosis. insomnia. jaundice. nausea. paraesthesia. peripheral neuritis. postural hypotension (more common in elderly). reflexes increased. skin reactions. suicidal tendencies. tremor. vision blurred. vomiting. weight increased SIDE-EFFECTS, FURTHER INFORMATION Risk of postural hypotension and hypertensive responses. Discontinue if palpitations or frequent headaches occur.
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Manufacturer advises avoid. Increased risk of neonatal malformations— manufacturer advises avoid unless there are compelling Nervous system reasons.
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Avoid—present in milk in animal studies.
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Manufacturer advises caution if transaminases are elevated; avoid in hepatic impairment or if transaminases exceed 3 times the upper limit of normal. In general, manufacturers advise avoid.
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Caution in moderate to severe impairment.
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Test liver function before treatment and after 3, 6, 12 and 24 weeks of treatment, and then regularly thereafter when clinically indicated (restart monitoring schedule if dose increased); discontinue if serum transaminases exceed 3 times the upper limit of reference range or symptoms of liver disorder. Monitor blood pressure (risk of postural hypotension and hypertensive responses).
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There can be variation in the licensing of different medicines containing the same drug. Tablet ▶Agomelatine (Non-proprietary) Agomelatine 25 mg Agomelatine 25mg tablets | 28 tablet P £34.48 DT = £31.90 ▶Valdoxan (Servier Laboratories Ltd) Agomelatine 25 mg Valdoxan 25mg tablets | 28 tablet P £30.00 DT = £31.90 ANTIDEPRESSANTS › MONOAMINE-OXIDASE INHIBITORS Monoamine-oxidase inhibitors f
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Hepatotoxicity Patients should be told how to recognise signs of liver disorder, and advised to seek immediate medical attention if symptoms such as dark urine, light coloured stools, jaundice, bruising, fatigue, abdominal pain, or pruritus develop. Patients should be given a booklet with more information on the risk of hepatic side-effects. Patients should be advised to eat only fresh foods and avoid food that is suspected of being stale or ‘going off’. This is especially important with meat, fish, poultry or offal; game should be avoided. The danger of interaction persists for up to 2 weeks after treatment with MAOIs is discontinued. Patients should also be advised to avoid alcoholic drinks or de-alcoholised (low alcohol) drinks. Driving and skilled tasks Drowsiness may affect performance of skilled tasks (e.g. driving). ANTIDEPRESSANTS › MONOAMINE- OXIDASE A AND B INHIBITORS, IRREVERSIBLE eiiii F above
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Withdrawal If possible avoid abrupt withdrawal. MAOIs are associated with withdrawal symptoms on cessation of therapy. Symptoms include agitation, irritability, ataxia, movement disorders, insomnia, drowsiness, vivid dreams, cognitive impairment, and slowed speech. Withdrawal symptoms occasionally experienced when discontinuing MAOIs include hallucinations and paranoid delusions. If possible MAOIs should be withdrawn slowly. Withdrawal effects may occur within 5 days of stopping treatment with antidepressant drugs; they are usually mild and self-limiting, but in some cases may be severe. The risk of withdrawal symptoms is increased if the antidepressant is stopped suddenly after regular administration for 8 weeks or more. The dose should preferably be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge (6 months in patients who have been on long-term maintenance treatment).
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25 mg daily, dose to be taken at bedtime, dose to
First-line fragment. Read the complete Indications and Dose section above.
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