Does Valdoxan (Agomelatine) Help Improve Deep Sleep?
Valdoxan (agomelatine) is not recommended for treating insomnia or improving deep sleep, as it is not FDA-approved for this indication and is not included in any major sleep medicine guidelines for insomnia treatment. 1, 2
Guideline Position on Agomelatine for Sleep
- The American Academy of Sleep Medicine's 2017 clinical practice guideline for chronic insomnia does not include agomelatine among evaluated or recommended medications for sleep disorders 1, 2
- The American College of Physicians' 2016 evidence report on insomnia pharmacologic treatment similarly does not evaluate or recommend agomelatine 1
- Agomelatine is mentioned only in the context of circadian rhythm disorders (not insomnia), where it appears in search strategies but without specific recommendations for use 1
What the Research Shows About Agomelatine and Sleep
While agomelatine is not guideline-recommended for sleep, research studies show some effects on sleep architecture:
- Sleep architecture improvements: Polysomnography studies demonstrate increased total sleep time, increased time in stage 2, stage 4 (deep sleep), and REM sleep, along with improved sleep efficiency 3
- Mechanism: Agomelatine acts as a melatonin receptor (MT1/MT2) agonist and serotonin 5-HT2C receptor antagonist, which can normalize circadian rhythms and improve slow-wave sleep 4, 5
- Context limitation: These sleep improvements were observed in patients being treated for major depressive disorder, not primary insomnia 3, 6
Critical Safety Concerns
- Hepatotoxicity risk: 3-4.5% of patients on 50 mg doses showed elevated transaminases, requiring repeated liver function monitoring during treatment 5, 7
- Agomelatine is contraindicated in patients with impaired liver function 7
Guideline-Recommended Alternatives for Deep Sleep/Sleep Maintenance
Instead of agomelatine, the American Academy of Sleep Medicine recommends these FDA-approved medications:
- Doxepin 3-6 mg: Provides 26-32 minutes improvement in total sleep time with small-to-moderate sleep quality improvement 1, 2, 8
- Eszopiclone 2-3 mg: Provides 28-57 minutes improvement in total sleep time with moderate-to-large sleep quality improvement 1, 2
- Zolpidem 10 mg: Provides 29 minutes improvement in total sleep time and 25 minutes reduction in wake after sleep onset 1, 2
- Suvorexant 10-20 mg: Reduces wake after sleep onset by 16-28 minutes 1, 2
Bottom Line
Agomelatine should not be used for treating insomnia or improving deep sleep outside the context of major depressive disorder treatment, as it lacks guideline support, FDA approval for this indication, and carries hepatotoxicity risks requiring monitoring. 1, 5, 7 If sleep improvement is the primary goal, use guideline-recommended medications with established efficacy and safety profiles for insomnia 1, 2