Agorest 25mg

Generic: Agomelatine

Manufacturer

Everest Pharmaceuticals Ltd.

৳ 35

Side Effects

The commonly reported adverse effects in the clinical trials of Agorest are headache, nausea and diarrhea. It is found to increase the level of liver enzymes and so monitoring of enzyme level is warranted before starting therapy and therefore every 6 weeks. It is also contraindicated in patients with hepatic impairment. A meta-analysis of the treatment emergent sexual dysfunction with antidepressants has revealed that it has no significant difference with placebo.

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Description

Indications

Agorest is indicated for the major depressive disorder in adults especially in non-responders and intolerant to selective serotonin reuptake inhibitors (SSRIs) including prevention of relapse.

Pharmacology

Agomelatine is a melatonergic agonist (MT1 and MT2 receptors) and 5-HT2C antagonist. Binding studies indicate that agomelatine has no effect on monoamine uptake and no affinity for a, (3 adrenergic, histaminergic, cholinergic, dopaminergic and benzodiazepine receptors. Agomelatine resynchronises circadian rhythms in animal models of circadian rhythm disruption. Agomelatine increases noradrenaline and dopamine release specifically in the frontal cortex and has no influence on the extracellular levels of serotonin.

Dosage & Administration

The effective dose of agomelatine is 25 mg per day given once at bed time for two weeks and can be increased to 50 mg per day in patients with inadequate response. Night time dosing is recommended because agomelatine improves the quality of sleep without day time sedation. For oral administration with or without food. Most adult patients should take a dosage of 25 mg (one tablet) daily. It is usually taking prior to bed time. If no improvement is noticed after two weeks, the dosage can be increased to 50 mg (two tablets) daily.

Children under 18 years: Should be given only on medical advice.

Use in children and adolescents: Agomelatine is not recommended in the treatment of depression in patients <18 years since safety and efficacy of agomelatine have not been established in this age group. In clinical trials among children and adolescents treated with other antidepressants, suicide-related behavior (suicide attempt and suicidal thoughts), and hostility (predominantly aggression, oppositional behavior and anger) were more frequently observed compared to those treated with placebo.

Use in the elderly: The efficacy and safety of agomelatine (25 to 50 mg/day) have been established in elderly patients with MDD (aged <75 years). As  efficacy has not been established in every elder patients aged >75 years agomelatine should not be used in this patient group.

Interaction

Agorest is metabolised mainly by cytochrome P450 1A2 (CYP1A2) (90%) and by CYP2C9/19 (10%). Medicinal products that interact with these isoenzymes may decrease or increase the bioavailability of Agorest. Fluvoxamine, a potent CYP1A2 and moderate CYP2C9 inhibitor markedly inhibits the metabolism of Agorest resulting in a 60-fold (range 12-412) increase of Agorest exposure. Consequently, co-administration of Agorest with potent CYP1A2 inhibitors (e.g. fluvoxamine, ciprofloxacin) is contraindicated.

Contraindications

Hypersensitivity to the active substances or to any of the excipients. Hepatic impairment (i.e cirrhosis or active liver disease), or transaminases exceeding 3 times upper limit of normal. Concomitant use of potent CYPIA2 inhibitors (eg. Fluvoxamine, ciprofloxacin).

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