Drilldown: Medicines

None · Codeine · 1,4-Butanediol · 1B-LSD · 1cP-LSD · 1P-LSD · 1V-LSD · 2-AI · 2-FA · 2-FDCK · 2-FMA · 25B-NBOH · 25B-NBOMe · 25C-NBOH · 25C-NBOMe · 25I-NBOH · 25I-NBOMe · 25N-NBOMe · 2C-B · 2C-B-FLY

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Belsomra (1) · Trintellix (US), Brintellix (formerly) (1) · Zulresso (1)

Dual orexin receptor antagonist (DORA) (1) · GABA-A positive allosteric modulator (1) · Multimodal antidepressant: SERT inhibitor + 5HT1A agonist + 5HT1B partial agonist + 5HT3/5HT7 antagonist (1) · Neuroactive steroid (1) · the first approved (1)

None (2) · Competitive antagonist at OX1R and OX2R. First-in-class DORA. Receptor dissociation slower than lemborexant or daridorexant. (1)

Insomnia (sleep onset and/or maintenance) in adults (FDA-approved August 2014). Also studied for insomnia in mild-moderate Alzheimer disease. (1) · Major depressive disorder in adults (FDA-approved 2013). Notable for evidence of cognitive benefit (processing speed) that distinguishes it from other antidepressants. (1) · Postpartum depression (PPD) in adults (1)

10 mg PO 30 min before bedtime (with ≥7 hours of sleep planned) (1) · 10 mg PO once daily; may increase to 20 mg as tolerated, or decrease to 5 mg if needed (1) · Single 60-hour continuous IV infusion: 30 mcg/kg/h × 4h → 60 mcg/kg/h × 20h → 90 mcg/kg/h × 28h → 60 mcg/kg/h × 4h → 30 mcg/kg/h × 4h (1)

100 mg/20 mL vial, single-use (1) · 5 mg, 10 mg, 15 mg, 20 mg tablets (1) · 5 mg, 10 mg, 20 mg tablets (1)

None · Indication-specific · 40 mg/d · 10 mg/d · 20 mg/d · 80 mg/d · 10 mg/d (adults) · 100 mg/d · 4 g/d · 400 mg/d · 40 mg/d typical; up to 240 mg/d for Zollinger-Ellison · 5 mg/d · 50 mg/d · 600 mg/d · No fixed ceiling; titrate to clinical effect and tolerability with CDC opioid prescribing guidance constraints on morphine-milligram-equivalent (MME) totals · No fixed maximum; titrated to TSH target · TID per eye · Titrated to glucose; no fixed ceiling · Titrated to glucose; no fixed maximum · '''20 mg/day in adults >60 years''' per FDA's 2011-2012 QT-prolongation warning; 40 mg/day in adults ≤60

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Intravenous (continuous infusion in a REMS-certified facility) (1) · Oral (2)

Antidepressant effect within hours of infusion start; sustained at 30 days (1) · Typical antidepressant 4-6 week onset (1) · ~30 min (1)

Daily dosing (1) · Single infusion course (1) · ~7-8 hours (1)

~12 hours (1) · ~66 hours (1) · ~9 hours (terminal) (1)

100% (IV) (1) · ~75% (1) · ~82% (1)

Limited data; avoid (1) · Limited data; weigh benefits/risks (1) · Medicine is structurally identical to endogenous allopregnanolone; pregnancy considerations relate to breastfeeding during/after infusion. Limited data; brief interruption of breastfeeding considered (1)

Rx (1) · Rx, Schedule IV (US) (1) · Rx; REMS program required (excessive sedation/loss of consciousness during infusion) (1)