Melatonin is generally well tolerated, and it has a low potential for abuse and no significant withdrawal effects. 11 Reassuringly, no detrimental effect on cognition or activities of daily living was detected. Although Wang and others, 10 in a metaanalysis published in 2017, reported that melatonin may improve nocturnal sleep time in patients with dementia, a Cochrane review published the previous year found no evidence that melatonin affected any major sleep outcomes in this population. 9Ĭaution should also be applied in the use of melatonin for patients with dementia. 9 However, there was significant heterogeneity among the included studies, with inconsistent effects, and the authors reiterated the need for larger and higher-quality trials. A meta-analysis of 6 tapering trials found no significant effect of melatonin on the odds of successful benzodiazepine discontinuation (odds ratio 0.72, 95% CI 0.21–2.41). For example, melatonin should not be substituted for a proper tapering regimen for benzodiazepine cessation. While melatonin may be useful in the aforementioned clinical settings, it is also worthwhile to highlight situations where its effectiveness has not been demonstrated. 7 It is also an option for patients who are blind and suffer from non–24-hour sleep–wake rhythm disorder, given evidence supporting circadian entrainment. In these settings, melatonin is considered the preferred pharmacological option for elderly patients. 4, 5Īlthough the effect of melatonin on typical insomnia is mild, it may be useful for other types of sleep disorders, including rapid eye movement sleep behaviour disorder, which is commonly associated with synucleinopathies such as Parkinson disease or Lewy body dementia. 6 However, more data are required for very elderly people, given that the mean age of patients in these studies was below 70 years. 3 Given the positive effect on sleep latency and a good tolerance profile in 2 large trials involving older adults, 4, 5 the British Association for Psychopharmacology consensus statement recommends prolonged-release melatonin as a first-line option for older patients when a hypnotic is indicated. 3 The AASM guideline does not recommend melatonin for insomnia in adults, because the quality of the evidence is lower, but it does report mixed evidence suggesting a possible greater improvement in sleep latency in the subpopulation of older adults (mean difference in sleep latency relative to placebo 16 min, 95% CI 6–25 min). 3 The practice guideline of the American Academy of Sleep Medicine (AASM) suggests ramelteon (a melatonin receptor agonist that is not available in Canada) as a treatment for sleep-onset insomnia, since its benefits marginally outweigh its harms, with limited to no consistent evidence of adverse events in excess of placebo (mean difference on sleep latency relative to placebo 10 min, 95% CI 6–13 min). 3 The effect on total sleep time or sleep quality is generally considered small or nonsignificant. More importantly, pharmacists should be aware of the situations where it has not been proven effective and therefore should not be recommended.įor chronic insomnia, melatonin has a statistically significant but relatively small effect on sleep latency, with a mean reduction of 9 min relative to placebo (95% confidence interval 2–15 min). 1 However, before considering this treatment, it is critical to determine the situations in which it may be effective and safe. 2 Research has shown that endogenous melatonin levels decline with age, thereby providing the rationale to use melatonin supplements for sleep. 1 In the United States, the most recent National Health Interview Survey showed that the overall use of melatonin among adults more than doubled between 20, to an estimated 3.1 million users. Sales of exogenous melatonin, a hormone that regulates the circadian rhythm, have increased significantly over the past few years.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |