Agoprex
Agoprex (Agomelatine 25 mg) — melatonin MT1/MT2 agonist for major depression with circadian disruption. no sexual dysfunction, no weight gain — needs LFT monitoring.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer
Agoprex (Agomelatine 25 mg) is a melatonin MT1/MT2 receptor agonist and 5-HT2C antagonist for major depression. Distinct profile: no sexual dysfunction, no weight gain, no discontinuation syndrome, but mandatory LFT monitoring.
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What Agoprex is and how it works
Agoprex is a 25 mg agomelatine tablet supplied by Sun Pharma. Agomelatine is mechanistically unique among antidepressants: it acts as an agonist at melatonin MT1 and MT2 receptors and an antagonist at 5-HT2C serotonin receptors. The dual mechanism resynchronises disrupted circadian rhythms (a feature of major depression) while indirectly increasing dopamine and noradrenaline release in the frontal cortex.
Agomelatine has no SERT activity, no anticholinergic effects, and no histaminergic effects — explaining its very different side-effect profile from SSRIs and TCAs.
Indications and dosing
| Indication | Starting | Target | Max |
|---|---|---|---|
| Major depression | 25 mg HS | 25 mg HS | 50 mg HS |
| Older adults / hepatic concern | 25 mg HS only | — | do not increase |
Always taken in the evening (peak at 1 hour, half-life 1–2 hours, but the receptor effect on circadian rhythm needs evening timing).
Important safety considerations
Agomelatine has a clinically significant hepatotoxicity signal — including rare cases of fulminant hepatitis. Mandatory LFTs at baseline, then at 3, 6, 12, and 24 weeks, then at every dose increase. Stop immediately if AST or ALT > 3× ULN, or if jaundice, dark urine, RUQ pain, or fatigue suggest hepatic injury. Contraindicated in any pre-existing hepatic impairment (Child-Pugh B or C), in transaminases > 3× ULN at baseline, and in heavy alcohol use.
Avoid concurrent fluvoxamine, ciprofloxacin, enoxacin — these raise agomelatine levels several-fold. Smoking cessation can raise levels (CYP1A2 is induced by smoking).
All antidepressants carry an FDA black-box warning for increased suicidal ideation in patients under 25.
Common side effects
- Common: headache, dizziness, somnolence, nausea, abdominal pain — usually mild and transient.
- Hepatic: transient AST/ALT rises (3–5%); rare clinically significant hepatitis.
- Distinctive negatives: no sexual dysfunction, no weight gain, no significant discontinuation syndrome — major selling points.
- Other: hyperhidrosis, anxiety on initiation, insomnia paradoxically in some patients.
Pregnancy, breastfeeding, paediatric
Pregnancy: limited data; not first-line. Breastfeeding: insufficient data. Paediatric: not approved <18 y.
Storage
Store at 15–30 °C in original packaging.
Frequently Asked Questions
Why bedtime dosing for Agoprex?
Agomelatine’s circadian-rhythm-resetting action is timed: evening dosing aligns the melatonergic phase shift with normal sleep onset. Morning dosing reduces the chronobiological benefit and is associated with worse antidepressant response in trials.
Why does Agoprex need LFT monitoring?
Approximately 3–5% of patients show transaminase elevation, and rare cases of severe hepatitis have been reported. The monitoring schedule (baseline, 3, 6, 12, 24 weeks, and dose increases) catches hepatic injury before it becomes clinically dangerous. Skipping LFTs is not safe.
Does Agoprex cause sexual dysfunction?
No — this is one of Agoprex’s strongest distinguishing features. Trial rates of sexual dysfunction are similar to placebo, dramatically lower than SSRIs.
Does Agoprex cause weight gain?
No — neutral to slightly weight-reducing in trials. Useful for patients who refused SSRIs because of weight concerns.
How long does Agoprex take to work?
Some patients notice sleep and energy improvements within 1–2 weeks (consistent with its melatonin action). Antidepressant effect builds over 4–6 weeks. Reassess at 6 weeks.
Can I stop Agoprex abruptly?
Discontinuation syndrome is minimal because of agomelatine’s very short half-life (1–2 hours) — there is no plasma drug accumulation to taper from. Most patients can stop directly without withdrawal effects, although some clinicians taper out of caution.
Can I drink alcohol on Agoprex?
Heavy alcohol use is contraindicated because of additive hepatotoxicity risk. Light/moderate alcohol is usually tolerated, but the combination is not advisable in any patient with elevated baseline LFTs.
How is Agoprex different from a sleeping pill?
Agoprex is not a hypnotic. It is an antidepressant that happens to improve sleep through circadian-rhythm normalisation. It does not cause next-day grogginess, does not have abuse potential, and the sleep effect is part of an overall mood-and-energy improvement rather than a primary sedation.
Will Agoprex interact with melatonin supplements?
Theoretical additive MT1/MT2 agonism but not clinically problematic at typical melatonin supplement doses. Most clinicians avoid the combination because there’s no benefit.
What if I miss a dose?
Skip and take the next dose at the usual evening time. Do not double up. Agomelatine’s short half-life means a missed dose has minimal carry-over.
Other Mental Health Medications
- Lexaheal (Escitalopram SSRI)
- Mirtaz (Mirtazapine NaSSA)
- Duvanta (Duloxetine SNRI)
- Flunil (Fluoxetine SSRI)
- Bupron XL (Bupropion XL — NDRI)
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| Strength | 25 mg |
|---|---|
| Quantity | 30 Tablet/s, 60 Tablet/s, 90 Tablet/s, 180 Tablet/s |
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Agoprex
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