II. Indications
- Refractory Postpartum Depression (age 15 years and older)
- May be used in combination with standard SSRI agents
III. Precautions
IV. Mechanism
- Mimics Allopregnanolone (GABA Receptor agent) which normally decreases in peripartum period
V. Dosing
- Intravenous infusion over 60 hours with onset of action by 24-48 hours
- Dosing protocol varies significantly over the course of the 60 hour infusion (30 to 90 mcg/kg/hour)
VI. Adverse Effects
- Cost in U.S. 2019: $34,000 for 60 hour course
- Risk of sedation and loss of consciousness (Black Box Warning, REMS program)
- Monitor for excessive sedation and apnea (e.g. Pulse Oximetry, Capnography)
VII. Safety
- Unknown safety in Lactation
- Avoid in pregnancy (may be Teratogenic)
- Use Contraception during treatment and for at least one week after completing medication
VIII. Resources
IX. References
- (2019) Presc Lett 26(5)