II. Indications
-
Postpartum Depression
- Major Depression starting in third trimester or first month postpartum AND
- Medication started within 12 months of delivery AND
- Refractory to other measures
III. Mechanism
- Similar to IV Brexanolone
- Mimics Allopregnanolone (GABA Receptor agent), known to decrease in peripartum period
- Zuranolone is a neuroactive steroid, GABA Type A receptor positive modulator
IV. Precautions
V. Dosing
- Standard Adult Dosing
- Take 50 mg orally with a fatty meal in the evening for 14 days
- Indications to decrease dose to 30 mg daily
- Severe hepatic Impairment (Child-Pugh C)
- Moderate or severe renal Impairment (eGFR <60 ml/min)
- Strong CYP3A4 Inhibitors (e.g. Azole Antifungals, Protease Inhibitors)
VI. Adverse Effects
- Costs $14,000 to $19,000 per 14 day course in 2024
- Drowsiness and confusion (36%)
- Avoid driving for 12 hours after each dose
- Avoid with other CNS Depressants (e.g. Opioids, Alcohol)
- Dizziness (13%)
- Diarrhea (6%)
VII. Safety
- Avoid in pregnancy (may be Teratogenic)
- Use Contraception during treatment and for at least one week after completing medication
- Unknown safety in Lactation
- May cause sedation in the nursing infant
- Zuranolone is found in Breast Milk, but at low levels (<1%)
- If choosing to pump and discard Breast Milk, may resume Breast Feeding 7 days after last dose
VIII. Drug Interactions
- Strong CYP3A4 Inhibitors (Azole Antifungals, Protease Inhibitors)
- Reduce Zuranolone dose to 30 mg orally daily
- Strong CYP3A4 Inducers (Phenytoin, Rifampin, Carbamazepine)
- Avoid with Zuranolone
IX. Resources
X. References
- (2024) Presc Lett 31(2): 10-11
- Montgomery (2025) Am Fam Physician 111(5): 465-6 [PubMed]