Astral Codex Ten

Zulresso

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Zulresso

Article

Zulresso is a recurring brand in the Astral Codex Ten archive, appearing 3 times across 3 issues between March 08, 2022 and March 16, 2022. The archive places it in contexts such as “Zulresso is the brand name of allopregnanolone (aka brexanolone), a new medication for post-partum depression”; “What studies were done on Zulresso? This followup study by Kanes was the first real RCT”; “the pharma company that owns the patent on Zulresso (and nothing else - this is their only drug!)“. It most often appears alongside allopregnanolone, progesterone, FDA.

Metadata

  • Category: Brands
  • Mention count: 3
  • Issue count: 3
  • First seen: March 08, 2022
  • Last seen: March 16, 2022

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Zounds! It's Zulresso and Zuranolone!
March 08, 2022 · Original source
Wikipedia describes Zulresso as “A bat-winged, armless toad with tentacles instead of a face... ” - no! sorry! That’s Zvilpogghua, one of the Great Old Ones from the Lovecraft mythos.
Inline links: describes
Zulresso is the brand name of allopregnanolone (aka brexanolone), a new medication for post-partum depression. It’s interesting as a potential missing link between hormones and normal mood regulation.
(source) GABA is the main inhibitory neurotransmitter; it’s usually associated with relaxation and sedation. A positive allosteric modulator is a chemical that makes receptors respond more strongly to their targets. So “a positive allosteric modulator of GABA” means a chemical that makes the brain respond stronger to relaxation/sedation signals. Sounds pretty useful! You may do some positive allosteric modulation of GABA yourself sometimes; this is one of the major actions of alcohol. Also of the benzodiazepines, a popular class of psychiatric medication including Ativan (lorazepam), Valium (diazepam), and Klonopin (clonazepam). The “-pam” at the end stands for positive allosteric modulator!
Inline links: source
Progesterone Megadoses Might Be A Cheap Zulresso Substitute
March 10, 2022 · Original source
Earlier this week we talked about Zulresso, a new medication for post-partum depression. It works well, but it can only be administered at a few special hospitals, and costs $35,000 per treatment.
Inline links: we talked about Zulresso
But Zulresso is a natural metabolite of the female hormone progesterone. What’s stopping people from taking progesterone, waiting for their bodies to metabolize it into Zulresso, and saving $35,000 and a hospital stay?
Andreen et al give some people a dose of 20 mg progesterone, then measure allopregnanolone levels. They find that the progesterone gets converted into allopregnanolone, with a max plasma concentration of about 8 nmol/L. This is about a fifth of allopregnanolone levels during pregnancy, which a course of Zulresso is trying to match. So in theory (and assuming simple pharmacokinetics) a dose of 100 mg progesterone ought to give the same peak level of allopregnanolone as a Zulresso infusion.
Inline links: Andreen et al
Highlights From The Comments On Zulresso
March 16, 2022 · Original source
Thanks to everyone who commented on Zounds! It’s Zulresso and Zuranolone and on the followup Progesterone Megadoses Might Be A Cheap Zulresso Substitute. I’m constantly impressed by the expertise of commenters here and on how much better the biomedical comment threads are compared to some of the others. Among the things I learned:
Inline links: Zounds! It’s Zulresso and Zuranolone, Progesterone Megadoses Might Be A Cheap Zulresso Substitute
— Metacelsus (who writes the blog De Novo) doubts the price estimates I posted:
Inline links: Metacelsus, De Novo
— Douglas (who writes the blog A Mindful Monkey) clears up some mechanism details I missed:
Inline links: Douglas, A Mindful Monkey