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Brexanolone

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Brexanolone, Zulresso

  • See Also
  1. Postpartum Depression
  2. Zuranolone
  • Indications
  1. Refractory Postpartum Depression (age 15 years and older)
    1. May be used in combination with standard SSRI agents
  • Precautions
  1. Schedule IV Controlled Substance
  • Mechanism
  1. Mimics Allopregnanolone (GABA Receptor agent) which normally decreases in peripartum period
  • 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)
  • 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)
  • 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
  • Resources
  1. Brexanolone (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b40f3b2a-1859-4ed6-8551-444300806d13
  • References
  1. (2019) Presc Lett 26(5)