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Zuranolone

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Zuranolone, Zurzuvae

  • See Also
  1. Postpartum Depression
  2. Brexanolone
  • Indications
  1. Postpartum Depression
    1. Major Depression starting in third trimester or first month postpartum AND
    2. Medication started within 12 months of delivery AND
    3. Refractory to other measures
  • Mechanism
  1. Similar to IV Brexanolone
  2. Mimics Allopregnanolone (GABA Receptor agent), known to decrease in peripartum period
  3. Zuranolone is a neuroactive steroid, GABA Type A receptor positive modulator
    1. Increases the inhibitory effects of GABA at the synaptic GABA type A receptor
  • Precautions
  1. Schedule IV Controlled Substance
  • Dosing
  1. Standard Adult Dosing
    1. Take 50 mg orally with a fatty meal in the evening for 14 days
  2. Indications to decrease dose to 30 mg daily
    1. Severe hepatic Impairment (Child-Pugh C)
    2. Moderate or severe renal Impairment (eGFR <60 ml/min)
    3. Strong CYP3A4 Inhibitors (e.g. Azole Antifungals, Protease Inhibitors)
  • Adverse Effects
  1. Costs $14,000 to $19,000 per 14 day course in 2024
  2. Drowsiness and confusion (36%)
    1. Avoid driving for 12 hours after each dose
    2. Avoid with other CNS Depressants (e.g. Opioids, Alcohol)
  3. Dizziness (13%)
  4. Diarrhea (6%)
  • Safety
  1. Avoid in pregnancy (may be Teratogenic)
    1. Use Contraception during treatment and for at least one week after completing medication
  2. Unknown safety in Lactation
    1. May cause sedation in the nursing infant
    2. Zuranolone is found in Breast Milk, but at low levels (<1%)
    3. If choosing to pump and discard Breast Milk, may resume Breast Feeding 7 days after last dose
  • Drug Interactions
  1. Strong CYP3A4 Inhibitors (Azole Antifungals, Protease Inhibitors)
    1. Reduce Zuranolone dose to 30 mg orally daily
  2. Strong CYP3A4 Inducers (Phenytoin, Rifampin, Carbamazepine)
    1. Avoid with Zuranolone
  • Resources
  1. Zuranolone (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f18e53b0-d0bb-422d-8de7-ab64b7292b29
  • References
  1. (2024) Presc Lett 31(2): 10-11
  2. Montgomery (2025) Am Fam Physician 111(5): 465-6 [PubMed]