II. Indications

  1. Postpartum Depression
    1. Major Depression starting in third trimester or first month postpartum
    2. Medication started within 12 months of delivery

III. Mechanism

  1. Similar to IV Brexanolone
  2. Mimics Allopregnanolone (GABA Receptor agent), known to decrease in peripartum period

V. Dosing

  1. Standard Adult Dosing
    1. Take 50 mg orally with a fatty meal in the evening for 14 days
  2. Indications to decrease dose to 30 mg daily
    1. Severe hepatic Impairment (Child-Pugh C)
    2. Moderate or severe renal Impairment (eGFR <60 ml/min)
    3. Strong CYP3A4 Inducer use

VI. Adverse Effects

  1. Costs $14,000 per 14 day course in 2024
  2. Drowsiness and confusion
    1. Avoid driving for 12 hours after each dose
    2. Avoid with other CNS Depressants (e.g. Opioids, Alcohol)

VII. Safety

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

VIII. Drug Interactions

  1. Strong CYP3A4 Inducers (Phenytoin, Rifampin)
    1. Reduce Zuranolone dose to 30 mg orally daily

X. References

  1. (2024) Presc Lett 31(2): 10-11

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