1. Introduction
Melatonin is a hormone naturally produced by the pineal gland, responsible for regulating the sleep-wake cycle. As a supplement, it is used for the treatment of sleep disorders such as insomnia, jet lag, and delayed sleep-wake phase disorder. It is classified as a dietary supplement in some regions and as a prescription medication in others. Melatonin’s mechanism of action involves mimicking natural melatonin to regulate circadian rhythms.
2. Indications
- Insomnia (short-term use)
- Jet lag
- Shift work sleep disorder
- Delayed sleep-wake phase disorder
- Sleep disturbances in children with neurodevelopmental disorders (e.g., autism, ADHD)
- Adjunct in improving sleep quality in elderly patients
3. Dosage
Adults:
- Insomnia: 2-5 mg taken 30-60 minutes before bedtime.
- Jet lag: 0.5-5 mg at bedtime, starting on the day of travel and continuing for several days after arrival.
- Shift work disorder: 2-3 mg taken before bedtime on non-workdays.
Children:
- 1-3 mg taken 30-60 minutes before bedtime (under medical supervision).
- Maximum dose: 5 mg/day.
Elderly:
- 1-2 mg of prolonged-release melatonin at bedtime.
4. Administration
- Take melatonin 30-60 minutes before bedtime for optimal effect.
- Avoid consuming caffeine or alcohol close to the time of administration.
- Prolonged-release formulations should not be crushed or chewed.
5. Forms Available
- Immediate-release tablets: 1 mg, 3 mg, 5 mg
- Prolonged-release tablets: 2 mg
- Liquid formulations: Various strengths
- Gummies and lozenges
6. Side Effects
6.1 Common Side Effects:
- Drowsiness
- Headache
- Dizziness
6.2 Less Common Side Effects:
- Nausea
- Irritability
- Abdominal discomfort
6.3 Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling)
- Worsening of mood in patients with depression
7. Warnings
- May impair the ability to drive or operate machinery.
- Use cautiously in patients with depression or epilepsy.
- Avoid in pregnancy or breastfeeding unless advised by a doctor.
8. Precautions
- Avoid long-term use without medical supervision.
- Monitor for possible interactions with other medications.
- Melatonin is not a substitute for practising good sleep hygiene.
9. Interactions
- CNS depressants (e.g., benzodiazepines): Increased sedative effects.
- Anticoagulants/antiplatelet drugs: May increase bleeding risk.
- Immunosuppressants: May reduce effectiveness.
- CYP1A2 inhibitors (e.g., fluvoxamine): Increased melatonin levels.
10. Monitoring Parameters
- Improvement in sleep onset and quality.
- Daytime alertness and functioning.
- Monitor for any worsening mood changes or irritability.
11. Use in Children
- Recommended only under medical supervision, especially for neurodevelopmental disorders.
- Safe short-term use has been observed, but long-term effects are not well established.
12. Use in Pregnancy
- Insufficient data on safety; avoid use unless absolutely necessary.
13. Use in Elderly
- Prolonged-release formulations are beneficial for age-related sleep disorders.
- Lower doses are recommended due to potential sensitivity.
14. Use in Kidney Disease
- No specific dose adjustments are recommended, but use with caution in severe kidney impairment.
15. Use in Liver Disease
- Not recommended due to reduced metabolism and potential accumulation of melatonin.
16. Patient Counselling Points
- Take melatonin 30-60 minutes before bedtime to help regulate your sleep cycle.
- Avoid caffeine, alcohol, or heavy meals before taking melatonin.
- Inform your healthcare provider if you experience mood changes or persistent drowsiness.
- Use melatonin as a short-term aid while practising proper sleep hygiene.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Circadin | Flynn Pharma | 2 mg Prolonged-Release | $15 (30 tablets) |
Natrol Melatonin | Natrol | 5 mg Immediate-Release | $10 (90 tablets) |
Mel-O-Chew | Vitafusion | 3 mg Chewable Tablets | $8 (60 tablets) |
18. 15 FAQs (Frequently Asked Questions)
1. What is melatonin?
Melatonin is a hormone that regulates the sleep-wake cycle, available as a supplement to treat sleep disorders.
2. How does melatonin work?
It mimics the action of natural melatonin, signalling the body to prepare for sleep.
3. What is the recommended dosage of melatonin?
Dosages typically range from 2-5 mg for adults, taken 30-60 minutes before bedtime.
4. Can melatonin be taken during pregnancy?
Melatonin is not recommended during pregnancy due to insufficient safety data.
5. Can I use melatonin while breastfeeding?
Its use is not recommended unless prescribed by a doctor.
6. What are the common side effects of melatonin?
Drowsiness, headache, and dizziness are common side effects.
7. Are there any serious risks associated with melatonin?
Rarely, melatonin can cause allergic reactions or worsen mood in individuals with depression.
8. What should I do if I miss a dose?
If you miss a dose, take it before your next bedtime. Do not double the dose.
9. What happens if I overdose on melatonin?
Overdose may cause excessive drowsiness, confusion, or headache. Seek medical advice if symptoms are severe.
10. Can melatonin interact with other medicines?
Yes, it can interact with anticoagulants, CNS depressants, and immunosuppressants.
11. Is melatonin safe for children?
Melatonin can be used under medical supervision, especially for neurodevelopmental disorders.
12. Is melatonin safe for elderly patients?
Yes, especially prolonged-release formulations for age-related sleep issues.
13. How should melatonin be stored?
Store at room temperature in a dry place away from direct light.
14. Do I need a prescription for melatonin?
This depends on the region; it is a prescription medication in some countries and an over-the-counter supplement in others.
15. Can melatonin be taken with alcohol or specific foods?
Avoid alcohol, as it may interfere with melatonin’s effectiveness.