Sponsored by Sage Therapeutics, Inc., and Biogen Inc.

Sponsored by Sage Therapeutics, Inc., and Biogen Inc.
Important Safety Information Prescribing Information
ZURZUVAE® (zuranolone) capsules IV 20mg • 25mg • 30mg
Consider ZURZUVAE for adult patients like 
these with postpartum depression (PPD)
IMPORTANT SAFETY INFORMATION
WARNING: IMPAIRED ABILITY TO DRIVE OR ENGAGE IN OTHER POTENTIALLY HAZARDOUS ACTIVITIES

ZURZUVAE causes driving impairment due to central nervous system (CNS) depressant effects.

Advise patients not to drive or engage in other potentially hazardous activities until at least 12 hours after ZURZUVAE administration for the duration of the 14-day treatment course. Inform patients that they may not be able to assess their own driving competence, or the degree of driving impairment caused by ZURZUVAE.
Please see additional Important Safety Information below.
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As nurse practitioners and physician associates, it is important that we support our patients when they are experiencing symptoms of postpartum depression (PPD). Some, like Lina, are experiencing depressive symptoms for the first time and may mistake them for the “baby blues.” Others, like Ava or Kiera, may have a history of depression and antidepressant use. That’s why I want to share information on an oral 14-day treatment option specifically indicated for adults with PPD—ZURZUVAE® (zuranolone). For patient profiles like these, and many others, the 14-day treatment course of ZURZUVAE may offer a novel way to treat PPD.1,2

[Trisha Joseph, PMHNP-BC]

Compensated by Sage Therapeutics and Biogen.
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Actor portrayals.

These are hypothetical profiles only. All treatment decisions should be up to the discretion of the HCP and patient, as each patient’s situation may vary.
Lina
Experiencing depressive symptoms for the first time in her life
Thought she had the baby blues, but symptoms persisted for weeks after giving birth
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Ava
Took an oral antidepressant in the past but discontinued and is hesitant to take it again
Frustrated by the worsening of depressive symptoms that emerged after giving birth
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Kiera
Prescribed an antidepressant prior to pregnancy, which she continues to take
Reports new, persistent depressive symptoms at a postpartum visit

IMPORTANT SAFETY INFORMATION (continued)

WARNINGS AND PRECAUTIONS

Impaired Ability to Drive or Engage in Other Potentially Hazardous Activities
ZURZUVAE causes driving impairment due to central nervous system (CNS) depressant effects
Advise patients not to drive a motor vehicle or engage in other potentially hazardous activities requiring complete mental alertness, such as operating machinery, until at least 12 hours after ZURZUVAE administration for the duration of the 14-day treatment course. Inform patients that they may not be able to assess their own driving competence or the degree of driving impairment caused by ZURZUVAE
Central Nervous System Depressant Effects
ZURZUVAE can cause CNS depressant effects such as somnolence and confusion
Somnolence developed in 36% of patients who received ZURZUVAE (50 mg) and in 6% of patients who received placebo daily. Some ZURZUVAE-treated patients developed confusional state. One of these cases was severe, and was also associated with somnolence, dizziness, and gait disturbance
A higher percentage of ZURZUVAE-treated patients, compared to placebo-treated patients, experienced somnolence, dizziness, or confusion that required dosage reduction, interruption, or discontinuation
Because ZURZUVAE can cause CNS depressant effects, patients may be at higher risk of falls
Other CNS depressants such as alcohol, benzodiazepines, opioids, tricyclic antidepressants, or drugs that increase zuranolone concentration, may increase impairment of psychomotor performance or CNS depressant effects such as somnolence, cognitive impairment, and the risk of respiratory depression in ZURZUVAE-treated patients
To reduce the risk of CNS depressant effects and/or mitigate CNS depressant effects that occurs with ZURZUVAE treatment:
If patients develop CNS depressant effects, consider dosage reduction or discontinuation of ZURZUVAE
If use with another CNS depressant is unavoidable, consider dosage reduction
Reduce the ZURZUVAE dosage in patients taking strong CYP3A4 inhibitors
Suicidal Thoughts and Behavior
In pooled analyses of placebo-controlled trials of chronically administered antidepressant drugs (SSRIs and other antidepressant classes) that included approximately 77,000 adult patients and 4,500 pediatric patients, the incidence of suicidal thoughts and behaviors in antidepressant-treated patients age 24 years and younger was greater than in placebo-treated patients. There was considerable variation in risk of suicidal thoughts and behaviors among drugs, but there was an increased risk identified in young patients for most drugs studied. There were differences in absolute risk of suicidal thoughts and behaviors across the different indications, with the highest incidence in patients with major depressive disorder (MDD)
ZURZUVAE does not directly affect monoaminergic systems. Consider changing the therapeutic regimen, including discontinuing ZURZUVAE, in patients whose depression becomes worse or who experience emergent suicidal thoughts and behaviors
Embryo-fetal Toxicity
Based on findings from animal studies, ZURZUVAE may cause fetal harm when administered to a pregnant woman
Advise a pregnant woman of the potential risk to an infant exposed to ZURZUVAE in utero. Advise females of reproductive potential to use effective contraception during treatment with ZURZUVAE and for one week after the final dose
ADVERSE REACTIONS
The most common adverse reactions (≥5% and greater than placebo) in ZURZUVAE-treated patients were somnolence, dizziness, diarrhea, fatigue, nasopharyngitis, and urinary tract infection
DRUG INTERACTIONS
CNS Depressant Drugs and Alcohol
Caution should be used when ZURZUVAE is administered in combination with other CNS drugs or alcohol. If use with another CNS depressant is unavoidable, consider dosage reduction
Strong CYP3A4 Inhibitors
Reduce the ZURZUVAE dosage when used with a strong CYP3A4 inhibitor
CYP3A4 Inducers
Avoid concomitant use of ZURZUVAE with CYP3A4 inducers
USE IN SPECIFIC POPULATIONS
Pregnancy
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants, including ZURZUVAE, during pregnancy. Healthcare providers are encouraged to register patients by calling the National Pregnancy Registry for Antidepressants at 1-844-405-6185 or visiting online at https://​womensmentalhealth.org/​research/​pregnancyregistry/​antidepressants/
Based on findings from animal studies, ZURZUVAE may cause fetal harm. Advise pregnant women of the potential risk to a fetus. Available data on ZURZUVAE use in pregnant women from the clinical development program are insufficient to evaluate for a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes
Lactation
Available data from a clinical lactation study in 14 women indicate that zuranolone is present in low levels in human milk. There are no data on the effects of zuranolone on a breastfed infant and limited data on the effects on milk production
The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for ZURZUVAE and any potential adverse effects on the breastfed child from ZURZUVAE or from the underlying maternal condition
Hepatic Impairment
The recommended ZURZUVAE dosage in patients with severe hepatic impairment (Child-Pugh C) is lower than patients with normal hepatic function
Renal Impairment
The recommended ZURZUVAE dosage in patients with moderate and severe renal impairment is lower than those with normal renal function
DRUG ABUSE AND DEPENDENCE
ZURZUVAE contains zuranolone, a Schedule IV controlled substance
Zuranolone has abuse potential with associated risks of misuse, abuse, and substance use disorder including addiction
ZURZUVAE may produce physical dependence
INDICATION

ZURZUVAE is indicated for the treatment of postpartum depression (PPD) in adults.

Please see full Prescribing Information, including Boxed Warning.
ZURZUVAE, a novel 14-day treatment for PPD,1,2 may be appropriate to treat these types of patients in your practice
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References: 1. ZURZUVAE Prescribing Information. Cambridge, MA: Biogen and Sage Therapeutics, Inc. 2. Deligiannidis KM, Meltzer-Brody S, Maximos B, et al. Zuranolone for the Treatment of Postpartum Depression. Am J Psych. 2023;180(9):668-675.
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