Valdoxane

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Valdoxane

Method of action: Antidepressant, Psychoanaleptics

Treatment option:

Medically reviewed

Marina Burgos

Last updated on 10/01/2026

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Valdoxane

What is Valdoxane?

Valdoxane is a prescription medication primarily used for the treatment of major depressive episodes in adults. It belongs to a class of medications known as antidepressants, but it operates through a distinct mechanism compared to traditional options like selective serotonin reuptake inhibitors (SSRIs).

Mechanism of Action

The active substance in Valdoxane is agomelatine. This compound works by interacting with specific receptors in the brain to influence the sleep-wake cycle and mood regulation. Its primary actions include:

  • Melatonergic Agonism: It mimics the effects of melatonin by binding to MT1 and MT2 receptors. These receptors are located in the suprachiasmatic nucleus, the area of the brain responsible for regulating the body's internal clock (circadian rhythm).
  • Serotonergic Antagonism: It blocks 5-HT2C receptors. This action is thought to increase the release of dopamine and noradrenaline in the frontal cortex of the brain, areas involved in mood control and cognitive function.

Clinical Purpose

Depression is often associated with disruptions in circadian rhythms, which can manifest as sleep disturbances and daytime fatigue. By targeting both melatonin and serotonin receptors, Valdoxane aims to resynchronize these rhythms and improve the symptoms of depression.

Unlike many other antidepressants, Valdoxane does not significantly affect the levels of serotonin itself, which results in a different profile of effects on the body. It is designed to address the emotional and physical symptoms of a depressive episode while helping to restore a more natural sleep-wake pattern.

Regulatory References

  1. EMA Public Assessment Report
  2. Valdoxane (Agomelatine) EPAR

What side effects are possible with Valdoxane?

Possible side effects and safety information

The safety profile for Valdoxane (agomelatine) is detailed in official regulatory documents, primarily focusing on potential adverse reactions and specific monitoring requirements.

Liver Function and Monitoring

The most distinctive safety feature is the documented risk of hepatic injury. This includes elevations in liver enzymes (transaminases), hepatitis, and, rarely, hepatic failure. Because of this risk, treatment is contraindicated in patients with pre-existing hepatic impairment, and liver function must be tested before treatment initiation and at mandated intervals (e.g., at 3, 6, 12, and 24 weeks) and when clinically indicated. Treatment is typically discontinued if liver enzymes exceed three times the upper limit of normal.

Frequency-Classified Adverse Reactions

Adverse reactions are classified by frequency as listed in regulatory documents:

  • Very Common: Headache.
  • Common: Dizziness, somnolence (sleepiness), insomnia, anxiety, nausea, diarrhoea, constipation, abdominal pain, fatigue, and increased liver enzymes.
  • Uncommon: Migraine, paraesthesia (pins and needles), suicidal thoughts or behaviour, agitation, aggression, and development of mania or hypomania.

Serious and Population-Specific Safety Notes

Serious adverse reactions documented in labeling include the rare occurrence of hepatic failure, angioedema, and the uncommon risk of suicidal thoughts or behaviour.

Population-specific safety statements note that use is not recommended for patients aged 75 years and above, nor for the paediatric population (under 18 years), due to limited or unestablished safety and efficacy data. The risk of suicidal behaviour is generally noted to be increased in young adults (under 25 years) taking antidepressants, consistent with findings across this class of medicine.

Overdose and Emergency Response

Overdose Map: Overdose and when to seek help — Official Regulatory Information for Valdoxane

The following information is derived strictly from government regulatory documentation (e.g., EMA Summary of Product Characteristics, TGA Product Information) regarding overdose with Agomelatine, the active ingredient in Valdoxane.


Overdose scope

Domain Official Regulatory Statement
Documented overdose presentations Reported symptoms include somnolence, fatigue, agitation, anxiety, tension, dizziness, malaise, and epigastralgia (pain in the upper stomach) [EMA/SmPC].
Physiological systems affected (as stated in label) Manifestations involve the central nervous system (CNS), gastrointestinal (GI) system, and the systemic sign cyanosis [EMA/SmPC].
Dose-related or exposure-related factors Overdose experience is limited. Cases involve Agomelatine taken alone or in combination with other psychotropic medicines.
Population-specific overdose notes Overdose data is particularly limited in elderly patients (ge65 years old) and in patients with moderate or severe renal impairment.
Emergency-response statements Management consists of treatment of clinical symptoms and routine supportive treatment.
When immediate medical help is required The patient must contact their doctor immediately or go to the nearest Emergency Department if an overdose is suspected.

Overdose classifications (high-level)

Classification Aspect Official Regulatory Statement
Severity classification The documented occurrence of cyanosis indicates the possibility of a serious systemic effect.
Regulatory basis Information is drawn from post-marketing surveillance and clinical data summarized in official prescribing information.
Overdose-context constraints No specific antidotes for Agomelatine are known.

Resulting overdose structure

Official overdose statements:

  • Patients must contact their doctor immediately if a dose larger than prescribed is taken.
  • Documented overdose presentations include somnolence, epigastralgia, and the systemic sign cyanosis.
  • Management for overdose consists of treatment of clinical symptoms and routine supportive treatment.
  • Regulatory data confirms that no specific antidotes for Agomelatine are known.

Connection to the overall overdose profile:

Regulatory documents define the overdose profile through a concise summary of reported manifestations and specific mandatory emergency actions. The profile emphasizes the lack of a specific antidote and the need for immediate, professional medical assessment for treatment of clinical symptoms and routine supportive treatment, irrespective of the amount taken.

Therapeutic Uses of Valdoxane

Quick Facts on Valdoxane Uses

  • Therapeutic Domain: Adult major depressive episodes.
  • Primary Goal: To help manage the associated symptoms of the condition.
  • Relapse Management: Used to help prevent symptoms from recurring in affected adults.

Valdoxane (agomelatine) is a prescription medication utilized in adults to support the management of major depressive episodes. The medication is an established therapeutic approach intended to provide symptom relief for those experiencing this condition.

The core use of this treatment is in the acute phase of major depression to help address the symptoms of a current episode. Furthermore, it is indicated for continuation treatment, with the goal of preventing the return of symptoms in adults who have already responded to the treatment and achieved stability. The therapeutic approach is associated with helping to restore overall well-being and managing the challenges associated with major depressive disorder.

Eligibility and Restrictions for Use

The eligibility for Valdoxane (agomelatine) is strictly defined by regulatory authorities and centers on patient health status and age.

Contraindicated Populations

Valdoxane is contraindicated for patients with hepatic impairment, including cirrhosis or active liver disease. Use is also prohibited if baseline serum transaminases (ALT and/or AST) exceed 3 times the Upper Limit of Normal (ULN). Patients with a known hypersensitivity to the medicine and those taking potent CYP1A2 inhibitors (such as fluvoxamine) are also ineligible.

Age and Special Population Restrictions

The medicine is primarily intended for adults aged 18 to less than 75 years. Valdoxane is not recommended for the treatment of children and adolescents (< 18 years), as safety and efficacy have not been established. Use is also not recommended in patients 75 years and older or in elderly patients with dementia. For breastfeeding women, use is not recommended.

Conditional Use and Caution

Use requires caution and close monitoring in patients with moderate or severe renal impairment and those with risk factors for liver injury (e.g., obesity or diabetes). Patients with a history of bipolar disorder or mania must also be carefully monitored.

What should I know about interactions with other medicines?

Interactions with other medicines and products

This section describes the officially documented interaction patterns for Valdoxane (agomelatine), based strictly on regulatory prescribing information.


Interaction Scope

Property Description (Regulatory Basis)
Medicinal product categories with documented interactions Potent and Moderate CYP1A2 Inhibitors, Oestrogens, CNS depressant medicinal products, CYP inducers.
Specific interacting medicines (if explicitly listed) Fluvoxamine, Ciprofloxacin, Propranolol, Enoxacin, Rifampicin.
Mechanistic basis of interactions Pharmacokinetic interaction (CYP1A2 enzyme inhibition/induction), Pharmacodynamic interaction (additive CNS depressant effect).
Timing-based interaction rules No mandatory timing or separation requirements are formally documented in the official regulatory labels.

Interaction-Related Restrictions

Property Description (Regulatory Basis)
Interaction severity classification Contraindicated (Potent CYP1A2 Inhibitors), Caution Should be Exercised (Moderate CYP1A2 Inhibitors, Alcohol).
Population-specific interaction notes Caution is advised for patients with hepatic risk factors, particularly those with substantial alcohol intake, due to increased risk of hepatic injury related to the drug’s metabolism.

Official Interaction Statements

  • Co-administration with Fluvoxamine and Ciprofloxacin is contraindicated. These are potent CYP1A2 inhibitors, and the combination results in a significant increase in agomelatine exposure.
  • Co-administration with moderate CYP1A2 inhibitors such as Oestrogens (e.g., oral contraceptives), Propranolol, and Enoxacin results in a several-fold increased exposure to agomelatine, and caution should be exercised.
  • The combination of Valdoxane with alcohol is officially not advisable due to the officially documented increased risk of hepatic injury.
  • Co-administration with other CNS depressant medicinal products may result in an additive increase in central nervous system depressant activities.
  • Substances that induce CYP1A2, such as Rifampicin or heavy smoking (ge 15 cigarettes/day), are officially documented to decrease the bioavailability of agomelatine.

Connection to the overall interaction profile:

Official regulatory documents define the product’s interaction structure primarily through its dependence on the CYP1A2 enzyme for metabolism, establishing a strict prohibition against co-administration with potent inhibitors of this pathway. The profile explicitly restricts co-use with alcohol and outlines necessary caution with other moderate CYP1A2 inhibitors and CNS depressants, based solely on documented pharmacokinetic and pharmacodynamic effects. Official labeling confirms the absence of mandatory dose spacing requirements.

Mechanism of Action

Agomelatine acts through a dual mechanism involving two different receptor families. It functions as an agonist (activator) at the mathbfMT1 and mathbfMT2 melatonin receptors while simultaneously operating as an antagonist (blocker) at the mathbf5- HT2 C serotonin receptor. This combination contributes significantly** to the molecule’s pharmacological profile, engaging two distinct signaling systems within the brain.

Agomelatine's agonism on the MT1/ MT2 receptors in the brain’s Suprachiasmatic Nucleus (SCN) directly supports the resynchronization of the internal biological rhythm. This action mediates the adjustment of the body's timing mechanisms, which influence the sleep-wake cycle and other physiological rhythms.

The antagonism of the 5- HT2 C receptor removes the inhibitory brake on specific neurons, leading to the selective increase in the release of Dopamine (DA) and Norepinephrine (NA), particularly within the prefrontal cortex. This disinhibition mechanism results in a localized increase of these monoamines, which is mechanistically linked to the molecule's synergistic effect on neurotrophic factors like BDNF.

Dosage and Administration Information

Administration Instructions for Valdoxane

Valdoxane (agomelatine 25 mg film-coated tablet) is a prescription-only medicine intended for oral use.

Standard Dosing and Schedule

  • Recommended Dose: The standard dose is 25 mg once daily.
  • Timing: The tablet must be taken at bedtime (in the evening).
  • Titration: If no sufficient improvement is observed after two weeks of treatment at the initial dose, the dose may be increased to the maximum recommended dose of 50 mg daily. The 50 mg dose requires taking two 25 mg tablets together at bedtime.
  • With/Without Food: The tablet may be taken with or without food.

Course of Treatment and Discontinuation

Instruction Type Guideline
Minimum Duration Treatment should continue for at least 6 months after improvement to help prevent symptoms from recurring.
Missed Dose If a dose is forgotten, do not take a double dose to compensate. Continue with the next scheduled dose at the usual time.
Cessation No dosage tapering is needed upon discontinuation of treatment.

Use in Specific Populations

  • Older Adults: The medication is established for use in adults under 75 years of age, with no dose adjustment required based solely on age in this group. Use is not recommended in patients 75 years and older.
  • Pediatric Population: Use is not recommended for children and adolescents below 18 years due to insufficient data on safety and efficacy.

Administration Requirement

As part of the usage protocol, liver function tests (LFTs) must be performed by a healthcare professional before starting treatment, when increasing the dosage to 50 mg, and then at specific intervals (e.g., around 3, 6, 12, and 24 weeks) during treatment.

Recent Clinical Evidence

Research evidence / Overview of studies for Valdoxane

Evidence for use in Acute Major Depressive Episodes

This section will summarize the research that supported the regulatory review of the medicine, including findings from short-term controlled trials, the outcome measures used (such as changes in symptom severity), and comparisons made against placebo or other active treatments.

The initial research for Valdoxane was conducted via short-term, randomized controlled trials (RCTs) focusing on adults experiencing major depressive episodes. The primary evidence consists of these controlled trials and comprehensive meta-analyses that consolidate findings from many studies. These trials were designed to observe patients over defined time intervals, typically lasting between six and twelve weeks.

Researchers primarily examined outcomes related to symptom intensity or variability by using standardized questionnaires to measure changes in the severity of depression. Research observed patterns related to the proportion of patients who met criteria for symptom reduction (known as "response") and those who met criteria for near-absence of symptoms (known as "remission"). Data indicate patterns related to differences in symptom scores compared to placebo. Formal reviews of the total evidence, including unpublished studies, have sometimes noted that the reported magnitude of this change was small. Furthermore, reported results exhibited variability across individual studies, which contributes to overall uncertainty about the consistency of results.

Long-term Studies and Prevention of Recurrence

This section will describe the design and patient populations of the continuation-phase studies, detailing what is documented in regulatory reviews about the long-term observation periods and the research focus on preventing the return of symptoms.

Research was conducted in patients who met criteria for stability during the initial acute phase; these studies explored long-term symptom changes to see if patterns were maintained. These long-term studies monitored a specific outcome: the time until the recurrence of a Major Depressive Episode (relapse) in patients included in the continuation phase of the trials. Findings describe patterns observed in these studies regarding the time to recurrence during the follow-up period. The number of dedicated, long-term studies is fewer than the short-term trials, and findings related to the long-term maintenance of stability have been mixed across systematic reviews. There is limited information for long-term outcomes extending significantly beyond one year.

Study Landscape and Areas of Uncertainty

The evidence base for the acute treatment of Major Depressive Episodes is derived from randomized controlled trials and meta-analyses; the overall evidence level is generally considered Moderate. Several limitations have been highlighted by scientific reviews. Follow-up durations were limited in many of the initial trials. Documented concerns exist regarding the potential for publication bias, where differences were observed between publicly reported findings and those submitted solely to regulatory agencies. Evidence is limited in patients aged 75 and over, and long-term effects of the compound studied are not fully established. Research is ongoing. Studies help show what has been observed so far, and the findings contribute to the broader evidence landscape.

Key Studies & References

  1. Efficacy and Safety of Agomelatine in Depressed Patients with Diabetes: A Systematic Review and Meta-Analysis (Gómez-Pérez et al.)

Frequently Asked Questions (FAQ)

Common questions about Valdoxane (FAQ)


Q: Is Valdoxane considered an antidepressant like Prozac or Zoloft?

Valdoxane is classified as an antidepressant, but it works differently from medications like SSRIs (Selective Serotonin Reuptake Inhibitors). Official documents describe its action as a unique dual mechanism, functioning as a melatonergic agonist and a specific serotonin receptor blocker. The drug's action is associated with regulating mood and supporting the body's internal biological clock.


Q: How quickly does Valdoxane usually start to affect sleep patterns?

Research on Valdoxane’s unique mechanism of action indicates a chronobiotic effect, meaning it helps to resynchronize the sleep-wake cycle. This specific action on the internal rhythm is established, although the time to full clinical benefit can vary. This effect is linked to the drug’s ability to activate melatonin receptors.


Q: Is Valdoxane habit-forming or addictive?

Official product information classifies Valdoxane as a Prescription-Only Medicine (POM). Clinical appraisals frequently note the reported absence of discontinuation symptoms when treatment is stopped, which serves as a factor that differentiates it from some other classes of psychiatric medications.


Q: What are the most common reasons a doctor might prescribe Valdoxane?

According to regulatory documents, Valdoxane is primarily indicated for the treatment of Major Depressive Episodes in adults. Its pharmacological profile focuses on mood stabilization and supporting the regulation of circadian rhythms (the body's internal clock).


Q: Are there any specific foods or drinks to avoid while taking Valdoxane?

Official regulatory documents state that Valdoxane tablets may be taken with or without food. However, caution is advised regarding alcohol intake. The official product information states that co-administration with substantial amounts of alcohol is not advised due to the documented increased risk of liver injury.


Q: Can Valdoxane affect weight or appetite?

Regulatory documents list changes in weight among the reported side effects. Weight gain is noted as a common side effect, while a decrease in weight is listed as an uncommon side effect in official documents.


Q: Are there concerns about driving or operating machinery while taking Valdoxane?

Official product information includes a safety warning advising caution, since the medicine can cause dizziness or sleepiness (somnolence). Official regulatory warnings advise caution, requiring patients to be certain their reactions are normal before engaging in these activities.


Q: What happens if you stop taking Valdoxane suddenly?

The product's label characteristics indicate that dosage tapering is not typically required when treatment with the medicine is stopped. Clinical studies and reviews often report that discontinuation symptoms are not typically observed upon stopping the medicine.


Q: Is Valdoxane a controlled substance?

Valdoxane is categorized as a Prescription-Only Medicine (POM) across the jurisdictions where it is authorized. Official regulatory documents do not classify the medicine as a controlled substance under a special schedule.


Q: Are there specific symptoms that mean Valdoxane should be stopped immediately?

Official safety documents state that treatment must typically be stopped if signs of liver injury are observed. This includes patient-observable symptoms such as unusual darkening of the urine, yellowing of the skin or eyes, light coloured stools, or pain in the upper right side of the abdomen. Patients who observe these symptoms are required by official documentation to seek urgent medical advice.


Q: Can Valdoxane cause strange dreams or nightmares?

Changes in dream activity have been reported in official product information. Abnormal dreams are listed as a common side effect, while nightmares are listed as an uncommon side effect in official documentation.


Q: Does Valdoxane interact with herbal supplements like St. John's Wort?

Official information indicates that caution is necessary with substances that cause the CYP1A2 enzyme to speed up (induce it), as this reduces the amount of Valdoxane in the body. This caution includes herbal supplements, such as St. John's Wort, that are known to have a similar effect on the CYP1A2 enzyme.


Q: What is meant by the term 'discontinuation symptoms' for Valdoxane?

Discontinuation symptoms are effects that can occur when stopping certain psychiatric medications. Clinical reports associated with Valdoxane generally indicate that such discontinuation symptoms are not typically reported when the medicine is stopped.


Q: How does Valdoxane work differently from SSRIs or SNRIs?

The mechanism of Valdoxane is unique in that it involves a dual action on both melatonin receptors and a specific serotonin receptor (5-HT2 C). In contrast, classes like SSRIs and SNRIs primarily work by inhibiting the reuptake of neurotransmitters like serotonin or norepinephrine. This represents a fundamental difference in how Valdoxane targets brain chemistry.


Q: Does taking Valdoxane require lifestyle changes?

The official product documentation advises on specific points related to lifestyle. Caution is advised regarding substantial alcohol intake due to liver risk, and heavy smoking (classified as 15 or more cigarettes per day) can affect how the medicine works in the body.


Q: Is Valdoxane known to cause sexual side effects?

Clinical reviews and studies have noted a low risk of treatment-emergent sexual dysfunction associated with the use of Valdoxane. This descriptive information on sexual dysfunction is part of the drug’s clinical profile.


Q: What should someone do if they suspect an allergic reaction to Valdoxane?

For any signs of a serious adverse reaction, such as an allergic reaction, official documentation requires that urgent medical attention be sought. This instruction applies to symptoms like swelling of the face, throat, tongue, or difficulty breathing, which can indicate hypersensitivity.


Q: Can Valdoxane affect blood pressure?

Clinical documents indicate that Valdoxane is not generally associated with adverse cardiac effects. Furthermore, official reviews have not noted specific changes in blood pressure during treatment.


Q: Is Valdoxane ever prescribed for anxiety?

The official regulatory approval for Valdoxane is strictly for Major Depressive Episodes. Although some research has explored the medicine’s anxiolytic (anxiety-reducing) potential, anxiety is not a recognized or approved indication for this medication.


Q: Does Valdoxane interact with over-the-counter cold and flu medications?

Regulatory documents advise caution when taking Valdoxane alongside medicines that cause sedation, which are known as Central Nervous System (CNS) depressants. Certain over-the-counter cold and flu medications may contain CNS depressants, and combining them with Valdoxane could result in additive sedative effects.


Q: What are the official guidelines regarding Valdoxane use during pregnancy or breastfeeding?

Official guidelines state that Valdoxane use is not recommended for women who are breastfeeding. For pregnant women, official documentation indicates that use is generally not recommended unless a healthcare professional determines the benefit outweighs the risk.


Q: Can Valdoxane be crushed or chewed if someone has trouble swallowing pills?

Official administration instructions state that the tablet must be swallowed whole and not crushed, chewed, or broken. This regulatory requirement is based on the need to maintain the integrity of the film-coated tablet for proper release of the medicine.

How should Valdoxane be stored and disposed of?

How to Store and Dispose of Valdoxane?

Valdoxane (agomelatine) tablets must be stored according to official regulatory conditions, which focus primarily on product stability and child safety.

Official Storage Conditions

Requirement Regulatory Statement
Temperature Does not require any special temperature storage conditions.
Protection Store in the original package to protect the medicine from moisture.
Child Safety Keep this medicine out of the sight and reach of children.
Expiration Do not use the medicine after the expiry date printed on the packaging.

Official Disposal Instructions

Any unused Valdoxane or waste material derived from the product should be disposed of strictly in accordance with local requirements. The official documentation advises against disposing of medicines via household waste or wastewater, unless specific local guidance states otherwise.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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