Melatonin

How does melatonin work?

The active ingredient in melatonin is N-acetyl-5-methoxytryptamine.

• Melatonin receptors are found in the pineal gland, which secretes the hormone, and releases it into your bloodstream to regulate your body's natural circadian rhythm. Simply put, the circadian rhythm is your body's internal clock. It alerts you when it's time to sleep, wake, and eat.
• Melatonin has strong antioxidant effects and it may strengthen your immune system. It also helps regulate blood pressure, blood glucose, weight, hormone levels, and body temperature.
• The role of melatonin is to aid your body's preparation for sleep, therefore those who do not make enough of it at night may have poor sleep quality.
• Many factors can contribute to decreased melatonin levels at night, including alcohol intake, smoking, caffeine usage, shift work, aging, some drugs, and exposure to excessive light at night, including blue light.
• Depending on the amount of melatonin you take, it may help counteract low levels and normalize your internal clock. You should consult with your doctor first to see if it's the best option for you. Melatonin may be beneficial to children and adolescents with sleep disturbances.

How do you use melatonin?

Follow all directions given to you by your doctor and read all documents provided, including the full Prescribing Information, FDA-Approved Product Labelling, Instructions for Use, and Medication Guide before using Melatonin. However, the following is a synopsis of the general guidelines for the use of melatonin:

• If you want to use melatonin for insomnia, start with a low-dose supplement. For example, begin with 0.5 to 1 milligrams (mg) 30 minutes before bedtime. If this does not help you fall asleep, consider increasing your dose to 3 to 5 mg. It is unlikely that taking more than 5 mg of melatonin can help you sleep faster. The idea is to discover the lowest dose that will help you sleep.
• However, before adding over-the-counter melatonin to your routine, follow the recommendations provided with your supplement and consult with a healthcare expert.
• Because melatonin comes in a variety of forms, you should speak with a doctor or pharmacist to determine which is best for you.
• Research suggests that melatonin is used for specific conditions such as:
• Insomnia
• Circadian rhythm sleep disorders in the blind
• Delayed sleep phase disorder (delayed sleep-wake phase sleep disorder) - where your sleep pattern is delayed two hours or more from a conventional sleep pattern, causing you to go to sleep later and wake up earlier
• Jetlag
• Shift work sleep disorder (SWSD) - occurs in people who work irregular hours such as split shifts, graveyard shifts, early morning shifts, or rotating shifts.
• Sleep disorders in children

What are the side effects of melatonin?

• Melatonin is a fairly safe, non-toxic hormone medication.
• For up to 3.5 years, no notable adverse events have been linked to daily melatonin use at dosages ranging from 2 to 10 mg.
• The most common side effects of melatonin seen in clinical trials as compared to placebo include:
• Daytime sleepiness and fatigue
• Dizziness and headaches
• Nausea
• Night sweats

These are not all of the possible side effects of melatonin. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Before starting melatonin, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including if you have:

• Dementia, as it can lead to additional adverse effects in older adults, such as daytime sleepiness. Consult your doctor before taking melatonin to avoid any potential negative effects.
• Alzheimer's disease, as this may interfere with thinking.

• Melatonin should be avoided in people with autoimmune illnesses because it can worsen some and alleviate others.
• High doses of melatonin supplements may interact with certain medications, such as blood thinners, seizure medications, birth control pills, high blood pressure meds, diabetes drugs, immunosuppressants, serotonin reuptake inhibitors (SSRIs), and other medications that are broken down by the liver.

Melatonin is quickly absorbed by the body. After taking the supplement, you will start to feel sleepy in about an hour. However, this will differ with each person.

Melatonin doesn’t last too long in the body. It has a half-life of 40 to 60 minutes, which is how long it takes the body to destroy half a medication. The medication is usually completely removed after four to five half-lives. This means melatonin will remain in the body for around 5 hours.

Remember that everyone's drug metabolism is unique, so this may not be the same timing for everyone.

When melatonin is taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking, including:

• Anticoagulant and anti-platelet medications, as well as herbal and nutritional supplements
• Anticonvulsants
• Blood pressure drugs
• Central nervous system (CNS) depressants
• Diabetes medications
• Contraceptive drugs
• Cytochrome P450 1A2 (CYP1A2) and cytochrome P450 2C19 (CPY2C19) substrates
• Fluvoxamine (Luvox)
• Immunosuppressants
• Medications that lower your seizure threshold

• Analgesia: Oral melatonin dosages ranging from 3 to 10 mg/day for varying durations have been used in a variety of pain disorders.
• Insomnia: 3 to 5mg daily, in the evening, over four weeks. Immediate-release melatonin (1 to 2 mg) taken 1 hour before bedtime may be beneficial in the elderly. Elderly patients should avoid controlled-release formulations due to concerns about prolonged concentration issues.
• Jet Lag (when traveling across different time zones): In general, smaller doses (0.5 to 2 mg orally) before flight and higher doses (5 mg orally) after trip for up to 4 days are indicated.

Keep out of the reach of children.

Store at room temperature or as directed on the package label. Protect from moisture. Throw away any unused medication after the expiration date.

There are many companies that manufacture generic or store-brand melatonin supplements.

Melatonin is available as a generic.

Since there is no physical dependency or withdrawal associated with melatonin, you can typically stop it immediately, without tapering it.

Given the little evidence available on safety and efficacy, melatonin supplementation during pregnancy is generally not recommended until more information is available. Talk to your doctor if you are already pregnant, or if you have any plans to become pregnant. They will know or recommend what is best for you.

Because your body naturally produces a certain level of melatonin, it will pass into your breast milk. Additionally, if you take melatonin supplements, some of it may also pass into the breast milk. The short-term use of melatonin is generally considered safe. However, more research is needed regarding the safety of using it long term. Talk to your doctor if you are already breastfeeding or if you have any plans to breastfeed. They will know or recommend what is best for you.