melatonin

General

Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

Pronunciation:
mel-uh-toh-nin

Trade Name(s)

• pineal hormone
• N-acetyl-5-methoxtryptamine

Ther. Class.

sedative/hypnotics

Common Uses

Sleep disorders (insomnia, jet lag, circadian rhythm disorders).

Action

Secreted by the pineal glad. Regulates secretion of growth hormone and gonadotropic hormones. It also possesses antioxidant activity.

Therapeutic Effect(s):

Improved sleep pattern.

Pharmacokinetics

Absorption: Unknown.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

TIME/ACTION PROFILE

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity;
• Autoimmune diseases.

Use Cautiously in:

• Diabetes;
• Hypertension;
• Hypotension;
• Seizure disorders;
• OB:   Safety not established in pregnancy;
• Lactation:  Safety not established in breastfeeding;
• Pedi:   Safety and effectiveness not established in children.

Adverse Reactions/Side Effects

CV: hypotension

GI: abdominal cramps, nausea, vomiting

Neuro: dizziness, drowsiness, excessive daytime somnolence, headache, irritability, nightmares

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Natural Drug Interaction

• Additive sedation with  CNS depressants.
• May ↑ bleeding risk with  antiplatelet agents  and  anticoagulants.
• May interfere with the glucose-lowering effects of  hypoglycemic agents.
• May ↓ effectiveness of  nifedipine.

Natural-Natural:

• May have additive sedative effects with herbs that have sedative properties, including  5-HTP,  kava,  St. John's wort, and  valerian .
• May ↑ risk of bleeding with herbs that have antiplatelet/anticoagulant properties, such as  clove,  garlic,  ginger,  gingko, and  ginseng .

Route/Dosage

PO (Adults): 0.3–10 mg once daily at bedtime.

Availability

Capsules: ^OTC

Tablets: ^OTC

Sublingual Tablets: ^OTC

Gummies: ^OTC

Assessment

• Assess sleep patterns before and periodically throughout therapy.

Lab Test Considerations:

Monitor blood glucose, coagulation panel, hormone panel, and lipid panel periodically during therapy.

Implementation

• PO Administer before bedtime.

Patient/Family Teaching

• Explain purpose and side effects of herb to patient. Advise patient to take at bedtime as directed.
• Advise patient to consult with health care provider before using any herbal supplement, especially when taken concurrently with Rx or OTC medications or vitamins.
• Advise patient to avoid driving and other activities requiring alertness until response to medication is known.
• Advise patient to avoid concurrent use of alcohol or other CNS depressants.
• Rep:  Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding before using this herb.

Evaluation/Desired Outcomes

Improved sleep pattern.