II. Indications

  1. Refractory Postpartum Depression (age 15 years and older)
    1. May be used in combination with standard SSRI agents

IV. Mechanism

  1. Mimics Allopregnanolone (GABA Receptor agent) which normally decreases in peripartum period

V. Dosing

  1. Intravenous infusion over 60 hours with onset of action by 24-48 hours
  2. Dosing protocol varies significantly over the course of the 60 hour infusion (30 to 90 mcg/kg/hour)

VI. Adverse Effects

  1. Cost in U.S. 2019: $34,000 for 60 hour course
  2. Risk of sedation and loss of consciousness (Black Box Warning, REMS program)
    1. Monitor for excessive sedation and apnea (e.g. Pulse Oximetry, Capnography)

VII. Safety

  1. Unknown safety in Lactation
  2. Avoid in pregnancy (may be Teratogenic)
    1. Use Contraception during treatment and for at least one week after completing medication

IX. References

  1. (2019) Presc Lett 26(5)

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