Food Supplements and Vitamins. Melatonin (N-acetyl-5-methoxytryptamine)

melatonin-sleeping-aid

Background

Melatonin is a hormone produced in the brain by the pineal gland from the amino acid tryptophan. The synthesis and release of melatonin are stimulated by darkness and suppressed by light, suggesting the involvement of melatonin in circadian rhythm and regulation of diverse body functions. Levels of melatonin in the blood are highest prior to bedtime.

Synthetic melatonin supplements have been used for a variety of medical conditions, most notably for disorders related to sleep.

Melatonin possesses antioxidant activity, and many of its proposed therapeutic or preventive uses are based on this property.

New drugs that block the effects of melatonin are in development, such as BMS-214778 or luzindole, and they may have uses in various disorders.

Dosing

NB! The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (over 18 years old)

Studies have evaluated 0,1-80 milligrams of melatonin taken nightly by mouth for up to three years for a variety of conditions. Research suggests that quick-release melatonin may be more effective than sustained-release formulations for sleep-related conditions. Intramuscular injections of 20 milligrams of melatonin have also been studied.

In studies of patients with melanoma, melatonin preparations have been applied to the skin. Patients are advised to discuss cancer treatment plans with an oncologist and pharmacist before considering use of melatonin either alone or with other therapies. For the prevention of sunburn, melatonin preparations, alone and in combination with ascorbic acid and vitamin E, in doses ranging from 20-100 milligrams in 70% ethanol, have been studied.

Intranasal melatonin (1% solution in ethanol) at a dose of two milligrams daily for one week has also been studied for high blood pressure.

A dose of 0.5 milligrams of transbuccal melatonin for two sessions on four consecutive nights, at least three days apart, has been studied for insomnia in the elderly.

There are other uses with limited supportive research and unclear effectiveness or safety. Use of melatonin for any condition should be discussed with a primary healthcare provider, appropriate specialist, and pharmacist prior to starting, and it should not be substituted for more proven therapies.

Children (under 18 years old)

There is limited study of melatonin supplements in children, and its safety is not established. Doses of up to up to nine or 10 milligrams per kilogram of body weight, as a single dose or over several months, have been studied. Use of melatonin should be discussed with the child’s physician and pharmacist prior to starting.

Safety

NB! There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in those with known allergies to melatonin or related products. There are rare reports of allergic skin reactions after taking melatonin by mouth. Melatonin has been linked to a case of autoimmune hepatitis.

Side Effects and Warnings

Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses (five milligrams daily) for up to two years. Available trials report that overall adverse effects are not significantly more common with melatonin than placebo.

Commonly reported adverse effects include fatigue, dizziness, headache, irritability, drowsiness, and sleepiness, although these effects may occur due to jet lag and not due to melatonin itself. Fatigue may occur particularly with morning use or high doses, and irregular sleep-wake cycles may occur. Disorientation, ataxia (difficulties with walking and balance), confusion, sleepwalking, vivid dreams, and nightmares have also been noted, with effects often resolving after the cessation of melatonin. Due to the risk of drowsiness or sedation, use caution if driving or operating heavy machinery.

Mild gastrointestinal distress commonly occurs, including nausea, vomiting, cramping, stomach pain, altered taste, abnormal feces, increased appetite, or diarrhea. Melatonin has been linked to the triggering of Crohn’s disease symptoms.

Other side effects include skin rash, infection, decreased mental performance, increased risk of inflammation, and increased urination.

It has been suggested that melatonin may lower the seizure threshold and increase the risk of seizure, particularly in children with severe neurologic disorders. However, multiple other studies actually report reduced incidence of seizure with regular melatonin use. This remains an area of controversy. Patients with seizure disorder taking melatonin should be monitored closely by a healthcare professional.

Mood changes have been reported, including giddiness and dysphoria (sadness). Psychotic symptoms have been reported, including hallucinations and paranoia, possibly due to overdose. Patients with underlying major depression or psychotic disorders taking melatonin should be monitored closely by a healthcare professional.

Melatonin may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Melatonin may cause drops in blood pressure. Caution is advised in patients taking medications that may also lower blood pressure.

Based on preliminary evidence, increases in cholesterol levels may occur. Caution is therefore advised in patients with high cholesterol levels or atherosclerosis, or in those at risk for cardiovascular disease. Abnormal heart rhythms have been associated with melatonin.

Hyperglycemia (elevated blood sugar levels) has been reported in patients with type 1 diabetes (insulin-dependent diabetes), and low doses of melatonin have reduced glucose tolerance and insulin sensitivity. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.

Hormonal effects have been reported, including decreases or increases in levels of luteinizing hormone, progesterone, estradiol, thyroid hormone (T4 and T3), growth hormone, prolactin, cortisol, oxytocin, and vasopressin. Gynecomastia (increased breast size) has been reported in men, as well as decreased sperm count (both which resolved with the cessation of melatonin). Decreased sperm motility and decreased libido have been reported in rats and humans.

It has been theorized that high doses of melatonin may increase intraocular pressure and the risk of glaucoma, age-related maculopathy and myopia, or retinal damage. However, there is preliminary evidence that melatonin may actually decrease intraocular pressure in the eye, and it has been suggested as a possible therapy for glaucoma. Patients with glaucoma taking melatonin should be monitored by a healthcare professional.

Use cautiously in patients using anesthetics, cytochrome P450 1A2 inhibitors like fluvoxamine, methamphetamine, nifedipine (a calcium channel blocker), or in children with a history of enuresis.

Avoid in patients using CNS depressants, including benzodiazepines and alcohol, as concomitant use may cause increased sedation.

Avoid use in women who are pregnant or are attempting to become pregnant, based on possible hormonal effects and a possible increased risk of developmental disorders.

Avoid with known allergies to melatonin or related products.

Pregnancy and Breastfeeding

Melatonin supplementation should be avoided in women who are pregnant or attempting to become pregnant, based on possible hormonal effects. High levels of melatonin during pregnancy may increase the risk of developmental disorders. In animal studies, melatonin was detected in breast milk and therefore should be avoided during breastfeeding. In men, decreased sperm motility and decreased sperm count are reported with the use of melatonin.

source: http://www.mayoclinic.com

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