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Medicines > classes : Stimulant or [[:Category:Melatonin receptor agonists|Melatonin receptor agonist]] or dissociative

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generic:
brand:
None (59) · Benzedrex (1) · DXM (1) · DXO (1) · Multiple OTC dietary supplement formulations (1) · Spravato (1)
classes: (Click arrow to add another value)
mechanism:
Monoamine releasing agent (8) · Dopamine/norepinephrine reuptake inhibitor (5) · NMDA antagonist (3) · None (2) · Cathinone analogue; monoamine reuptake inhibitor (2) · Dopamine and norepinephrine reuptake inhibitor (2) · NMDA antagonist; sigma receptor agonist (2) · Norepinephrine–dopamine reuptake inhibitor (2)
uses:
None (62) · Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020). (1) · '"`UNIQ--vote-0000001B-QINU`"', '"`UNIQ--vote-0000001C-QINU`"', '"`UNIQ--vote-0000001D-QINU`"', '"`UNIQ--vote-0000001E-QINU`"', '"`UNIQ--vote-0000001F-QINU`"', '"`UNIQ--vote-00000020-QINU`"' (1)
starting dose:
None (62) · 0.5-3 mg PO 30-60 minutes before bedtime. Some patients respond to micro-doses (0.3 mg) without additional benefit at higher doses. For circadian phase shifting, timing relative to dim-light melatonin onset matters more than absolute dose (1) · Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site. (1)
preparations:
None (62) · 28 mg/device (each dose uses 2 devices) (1) · OTC tablets, sublingual tablets, gummies, liquid, extended-release tablets and capsules; common strengths 0.5, 1, 3, 5, 10 mg (1)
fda max:
None (62) · 84 mg per session (1) · Not formally established (dietary supplement); doses above ~3-5 mg show no additional efficacy but increase next-day sedation risk (1)
routes:
None (62) · Intranasal (under direct medical supervision) (1) · Oral (1) · sublingual (1)
onset:
None (62) · 30-60 minutes (immediate-release oral) (1) · Within hours of first administration (1)
duration:
None (62) · 3-4 hours (1) · Acute effect ~24 hours; cumulative effect builds with repeated dosing (1)
halflife:
None (62) · 30-50 minutes (short)'"`UNIQ--ref-00000021-QINU`"' (1) · ~7-12 hours (1)
bioavailability:
None (62) · ~15% (oral; highly variable due to extensive and variable first-pass metabolism)'"`UNIQ--ref-00000022-QINU`"' (1) · ~48% intranasal (1)
pregnancy:
None (62) · Avoid; may cause fetal harm (1) · Limited human data; endogenous hormone, but supplemental pharmacological doses are not well characterized in pregnancy.<sup class="pcp-cn" title="This claim needs a citation.">&#91;[[Pharmacopedia:Citation needed|citation&nbsp;needed]]&#93;</sup> (1)
legal:
None (62) · Rx, Schedule III (US). REMS program required. (1) · [[USLegal:Over-the-counter|OTC]] dietary supplement in the US ('''not FDA-regulated as a medicine'''; multiple studies show OTC products contain 50-470% of labeled melatonin content); [[USLegal:Prescription only|Rx-only]] in the EU and UK (1)

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