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Lee SKM, Yeung KWCM, Bin YS, Smith L, Tan ECK, Cairns R, Cheung JMY. Melatonin Use in School-Aged Children and Adolescents: An Exploration of Caregiver and Pharmacist Perspectives. Behav Sleep Med 2024:1-20. [PMID: 39277823 DOI: 10.1080/15402002.2024.2396838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
OBJECTIVE This study aims to explore the perspectives and experiences of Australian caregivers and community pharmacists about pediatric melatonin use. METHODS A convenience sample of caregivers with children (aged 11-16 years) using melatonin as a sleep aid and community pharmacists (including pharmacist interns) were recruited. Participants first completed an online survey followed by an online semi-structured interview. Interviews were guided by a schedule of questions for the respective participant groups, broadly exploring their beliefs about melatonin, experiences in using/supplying melatonin, and perceived facilitators/barriers for melatonin use. Interviews were digitally recorded, transcribed verbatim, and analyzed using the Framework Approach. RESULTS Fourteen caregivers of predominantly neurodiverse adolescents and 24 community pharmacists were interviewed. While melatonin was perceived by caregivers of both typically developing and neurodiverse dependants as safer than pharmacological sleep aids, treatment was only initiated after trialling non-pharmacological strategies first. Pharmacists expressed concerns around the ambiguities in practice and the limited scope of existing resources for guiding pediatric melatonin use. Caregivers frequently deferred to the information available online to procure products or self-adjust doses and dosing schedules. Both pharmacists and caregivers emphasized the need for more affordable and age-appropriate proprietary formulations that are readily accessible. CONCLUSION Melatonin is administered predominantly by caregivers of neurodiverse adolescents to address their sleep disturbances. The findings underscore the need for reliable, evidence-based information to guide safe and appropriate use of melatonin in pediatric populations. Patient education is also warranted to address maladaptive medication-administration practices. Lastly, there is a need for stronger regulatory oversight of melatonin products to ensure their quality and safety of use.
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Affiliation(s)
- Samantha K M Lee
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, Sydney, Australia
| | - Kingston W C M Yeung
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Yu Sun Bin
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Lorraine Smith
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Edwin C K Tan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rose Cairns
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Janet M Y Cheung
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sleep Research Group, Charles Perkins Centre, The University of Sydney, Sydney, Australia
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Chang P, Amaral LJ, Hou YNJ, Gubili J, Asher A. Fast Facts and Concepts #483: Commonly Used Supplements for Cancer-Related Symptom Management. J Palliat Med 2024; 27:951-953. [PMID: 38770676 DOI: 10.1089/jpm.2024.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
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Bruni O, Biggio G, Malorgio E, Nobili L. Insomnia in children affected by autism spectrum disorder: The role of melatonin in treatment. Sleep Med 2024; 119:511-517. [PMID: 38805858 DOI: 10.1016/j.sleep.2024.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/08/2024] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
The present article explores the connection between insomnia and Autism Spectrum Disorder (ASD), focusing on the efficacy and safety of melatonin treatments as supported by existing research and current guidelines. In this narrative review a group of Italian experts provide an analysis of the various aspects of managing insomnia in children with ASD, highlighting key points that could enhance the quality of life for both patients and their caregivers. This includes the significance of comprehensively understanding the root causes of a child's sleep difficulties for more effective, long-term management. Insomnia, a condition frequently documented in neurodevelopmental disorders such as ASD, greatly affects the lives of patients and caregivers. Recent data show that melatonin-based formulations are effective and safe for treating ASD-related insomnia both short and long term. In particular, prolonged-release melatonin is poised to be the optimal choice for this patient population. This formulation is approved for the treatment of insomnia in children and adolescents aged 2-18 years suffering from ASD and/or Smith-Magenis syndrome, where sleep hygiene measures and behavioral treatments have not been sufficient. In support, emerging research in pediatric settings indicates long-term efficacy and safety, although further research efforts are still needed. Current guidelines recommend managing insomnia and sleep disturbances in ASD using a combination of behavioral and pharmacological methods, primarily melatonin. Recent concerns about accidental melatonin ingestion highlight the need for high purity standards, such as pharmaceutical-grade prolonged-release formulations. The article also summarizes emerging molecular mechanisms from preclinical research, suggesting future therapeutic approaches.
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Affiliation(s)
- Oliviero Bruni
- Dept of Developmental and Social Psychology, Sapienza University, Via dei Marsi 78, 00185, Rome, Italy.
| | - Giovanni Biggio
- Department of Life and Environmental Sciences, Institute of Neuroscience, CNR, University of Cagliari, 09042, Cagliari, Italy; Institute of Neuroscience, National Research Council (C.N.R.), University Campus, 09042, Cagliari, Italy.
| | - Emanuela Malorgio
- Italian Federation of Primary Care Pediatricians (Federazione Italiana Medici Pediatri, FIMP), Expert on Sleep Disorders AIMS, Torino, Italy.
| | - Lino Nobili
- IRCCS G. Gaslini Institute. Department of Neuroscience - Rehabilitation - Ophthalmology - Genetics - Child and Maternal Health (DINOGMI) - University of Genova, Italy.
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de Lima Menezes G, Sales Bezerra K, Nobre Oliveira JI, Fontenele Araújo J, Soares Galvão D, Alves da Silva R, Vogel Saivish M, Laino Fulco U. Quantum mechanics insights into melatonin and analogs binding to melatonin MT 1 and MT 2 receptors. Sci Rep 2024; 14:10922. [PMID: 38740789 PMCID: PMC11091226 DOI: 10.1038/s41598-024-59786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Melatonin receptors MT1 and MT2 are G protein-coupled receptors that mediate the effects of melatonin, a hormone involved in circadian rhythms and other physiological functions. Understanding the molecular interactions between these receptors and their ligands is crucial for developing novel therapeutic agents. In this study, we used molecular docking, molecular dynamics simulations, and quantum mechanics calculation to investigate the binding modes and affinities of three ligands: melatonin (MLT), ramelteon (RMT), and 2-phenylmelatonin (2-PMT) with both receptors. Based on the results, we identified key amino acids that contributed to the receptor-ligand interactions, such as Gln181/194, Phe179/192, and Asn162/175, which are conserved in both receptors. Additionally, we described new meaningful interactions with Gly108/Gly121, Val111/Val124, and Val191/Val204. Our results provide insights into receptor-ligand recognition's structural and energetic determinants and suggest potential strategies for designing more optimized molecules. This study enhances our understanding of receptor-ligand interactions and offers implications for future drug development.
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Affiliation(s)
- Gabriela de Lima Menezes
- Departamento de Biofísica e Farmacologia, Universidade Federal do Rio Grande no Norte, Natal, RN, 59072-970, Brazil
- Bioinformatics Multidisciplinary Environment, Programa de Pós Graduação em Bioinformática, Universidade Federal do Rio Grande do Norte, Natal, RN, 59078-400, Brazil
| | - Katyanna Sales Bezerra
- Departamento de Biofísica e Farmacologia, Universidade Federal do Rio Grande no Norte, Natal, RN, 59072-970, Brazil
- Applied Physics Department, University of Campinas, Campinas, São Paulo, 13083-859, Brazil
| | - Jonas Ivan Nobre Oliveira
- Departamento de Biofísica e Farmacologia, Universidade Federal do Rio Grande no Norte, Natal, RN, 59072-970, Brazil
| | - John Fontenele Araújo
- Departamento de Fisiologia e Comportamento, Universidade Federal do Rio Grande no Norte, Natal, RN, 59072-970, Brazil
| | - Douglas Soares Galvão
- Applied Physics Department, University of Campinas, Campinas, São Paulo, 13083-859, Brazil
| | - Roosevelt Alves da Silva
- Unidade Especial de Ciências Exatas, Universidade Federal de Jataí, Jataí, GO, 75801-615, Brazil
| | - Marielena Vogel Saivish
- Laboratório de Pesquisas em Virologia, Departamento de Doenças Dermatológicas, Infecciosas e Parasitárias, Faculdade de Medicina de São José Do Rio Preto, São José Do Rio, Preto, SP, 15090-000, Brazil
- Centro Nacional de Pesquisa em Energia e Materiais (CNPEM), Brazilian Biosciences National Laboratory, Campinas, SP, 13083-100, Brazil
| | - Umberto Laino Fulco
- Departamento de Biofísica e Farmacologia, Universidade Federal do Rio Grande no Norte, Natal, RN, 59072-970, Brazil.
- Bioinformatics Multidisciplinary Environment, Programa de Pós Graduação em Bioinformática, Universidade Federal do Rio Grande do Norte, Natal, RN, 59078-400, Brazil.
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5
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Tse ACY, Lee PH, Sit CHP, Poon ETC, Sun F, Pang CL, Cheng JCH. Comparing the Effectiveness of Physical Exercise Intervention and Melatonin Supplement in Improving Sleep Quality in Children with ASD. J Autism Dev Disord 2023:10.1007/s10803-023-06172-7. [PMID: 37950776 DOI: 10.1007/s10803-023-06172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
PURPOSE Previous studies have demonstrated that physical exercise can modulate the endogenous melatonin level in children with autism spectrum disorder (ASD) and improve their sleep quality. However, it remains unclear whether physical exercise or melatonin supplement, or a combination of both, is more effective in improving sleep quality in this population. The purpose of this study is to answer this research question by comparing the effectiveness of three types of interventions (physical exercise vs. melatonin supplement or a combination of both) in improving sleep quality in children with ASD. METHODS Sixty-two (62) children diagnosed with ASD were randomly assigned to one of four groups: cycling (n = 18), melatonin supplement (n = 14), a combination of both (n = 12), and placebo control group (n = 18). Four (4) sleep parameters (sleep efficiency, sleep onset latency, sleep duration, and wake after sleep onset) were assessed. RESULTS The results revealed a significant improvement in sleep efficiency, sleep onset latency, and sleep duration in all of the interventions, but not in the placebo control group. However, no significant group differences were found among the interventions (ps > .05). CONCLUSION Our findings suggest similar effectiveness of physical exercise and melatonin supplementation in improving sleep quality in children with ASD.
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Affiliation(s)
- Andy C Y Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Rm D4-2/F-02, Block D4, 10 Lo Ping Road, Tai Po, N.T, Hong Kong, China.
| | - Paul H Lee
- Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, Chinese University of Hong Kong, Hong Kong, China
| | - Eric Tsz-Chun Poon
- Department of Sports Science and Physical Education, Chinese University of Hong Kong, Hong Kong, China
| | - F Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Rm D4-2/F-02, Block D4, 10 Lo Ping Road, Tai Po, N.T, Hong Kong, China
| | - Chi-Ling Pang
- School of Education, John Hopkins University, Baltimore, USA
| | - James C H Cheng
- Department of Paediatrics and Adolescent Health, United Christian Hospital, Hong Kong, China
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Wu L, Isah Bindawa M, Zhang S, Dang M, Zhang X. Development of indirect competitive ELISA and CLEIA for quantitative analysis of melatonin in health products. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2023; 15:5545-5552. [PMID: 37847386 DOI: 10.1039/d3ay01182h] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Melatonin (MT), as a hormone regulating the rhythm of sleep, is widely used in health products. However, illicit and excessive use of MT might cause undesirable effects. Therefore, it is essential to establish highly sensitive and specific rapid methods for MT analysis in health products. In this study, we established indirect competitive enzyme-linked immunosorbent assay (ic-ELISA) and indirect competitive chemiluminescent enzyme immunoassay (ic-CLEIA) for sensitive and selective detection of MT in health products. Under optimal conditions, half-maximum inhibitory concentration (IC50 value) and limit of detection (LOD, IC10 value) for MT by ic-ELISA were 0.25 ng mL-1 and 0.03 ng mL-1 respectively, while the IC50 and LOD of ic-CLEIA were lower at 0.17 ng mL-1 and 0.03 ng mL-1 respectively. Three MT-free Chinese patent medicines were spiked with MT and the recovery rates ranged from 71.89% to 117% (ic-ELISA) and 83.66% to 107.17% (ic-CLEIA). The level of MT in six MT-containing health products was assessed in parallel using the developed methods and HPLC. Both ic-ELISA and ic-CLEIA showed good consistencies (R2 = 0.999 and 0.993, respectively) with HPLC, indicating that the two methods developed were sensitive, fast, and reliable for application in MT analysis.
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Affiliation(s)
- Longjiang Wu
- Chinese-German Joint Laboratory for Natural Product Research, Qinba State Key Laboratory of Biological Resources and Ecological Environment, College of Biological Science and Engineering, Shaanxi University of Technology, Hanzhong 723000, Shaanxi, China
| | - Murtala Isah Bindawa
- Department of Biochemistry, Faculty of Natural and Applied Sciences, Umaru Musa Yar'adua University Katsina, Katsina, Nigeria
- Biomedical Science Research and Training Centre, Yobe State University, Damaturu, Nigeria
| | - Siran Zhang
- Xi'an Middle School of Shaanxi Province, Fengcheng Wulu 69, Weiyang, Xi'an, China
| | - Mei Dang
- Chinese-German Joint Laboratory for Natural Product Research, Qinba State Key Laboratory of Biological Resources and Ecological Environment, College of Biological Science and Engineering, Shaanxi University of Technology, Hanzhong 723000, Shaanxi, China
| | - Xiaoying Zhang
- Chinese-German Joint Laboratory for Natural Product Research, Qinba State Key Laboratory of Biological Resources and Ecological Environment, College of Biological Science and Engineering, Shaanxi University of Technology, Hanzhong 723000, Shaanxi, China
- Department of Biology, Centre of Molecular & Environmental Biology, University of Minho, 4710-057, Braga, Portugal
- Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, N1G 2W1, Guelph, Ontario, Canada.
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Alcocer Alkureishi L, Hageman JR, Munoz TI. What's Sleep Got to Do With It? Pediatr Ann 2023; 52:e313-e315. [PMID: 37695286 DOI: 10.3928/19382359-20230809-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
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8
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Terziev D, Terzieva D. Experimental Data on the Role of Melatonin in the Pathogenesis of Nonalcoholic Fatty Liver Disease. Biomedicines 2023; 11:1722. [PMID: 37371817 DOI: 10.3390/biomedicines11061722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the increasing prevalence of nonalcoholic fatty liver disease (NAFLD) worldwide, its complex pathogenesis remains incompletely understood. The currently stated hypotheses cannot fully clarify the interrelationships between individual pathogenetic mechanisms of the disease. No appropriate health strategies have been developed for treating NAFLD. NAFLD is characterized by an accumulation of triglycerides in hepatic cells (steatosis), with the advanced form known as nonalcoholic steatohepatitis. In the latter, superimposed inflammation can lead to fibrosis. There are scientific data on NAFLD's association with components of metabolic syndrome. Hormonal factors are thought to play a role in the development of metabolic syndrome. Endogenous melatonin, an indoleamine hormone synthesized by the pineal gland mainly at night, is a powerful chronobiotic that probably regulates metabolic processes and has antioxidant, anti-inflammatory, and genomic effects. Extrapineal melatonin has been found in various tissues and organs, including the liver, pancreas, and gastrointestinal tract, where it likely maintains cellular homeostasis. Melatonin exerts its effects on NAFLD at the cellular, subcellular, and molecular levels, affecting numerous signaling pathways. In this review article, we discuss the experimental scientific data accumulated on the involvement of melatonin in the intimate processes of the pathogenesis of NAFLD.
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Affiliation(s)
- Dimitar Terziev
- Second Department of Internal Medicine, Gastroenterology Section, Faculty of Medicine, Medical University, 4002 Plovdiv, Bulgaria
| | - Dora Terzieva
- MDL "Bioiv", Medical University, 4002 Plovdiv, Bulgaria
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Venaki E, Koukkou E, Ilias I. Melatonin’s actions are not limited to sleep. World J Exp Med 2023; 13:4-6. [PMID: 36970311 PMCID: PMC10037225 DOI: 10.5493/wjem.v13.i2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/18/2023] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
Melatonin is widely available as a supplement, usually for sleep disorders. The consumption of melatonin supplements has increased considerably in recent years. An overlooked aspect of melatonin’s administration is the resulting increase in prolactin secretion, via its action on hypothalamic dopaminergic neurons. We believe that since the effect of melatonin on prolactin is tangible, the laboratory finding of hyperprolactinemia could be encountered more often, given the increase in melatonin’s use. This is an issue that merits further study.
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Affiliation(s)
- Evangelia Venaki
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Eftychia Koukkou
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
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Meléndez-Fernández OH, Liu JA, Nelson RJ. Circadian Rhythms Disrupted by Light at Night and Mistimed Food Intake Alter Hormonal Rhythms and Metabolism. Int J Mol Sci 2023; 24:3392. [PMID: 36834801 PMCID: PMC9963929 DOI: 10.3390/ijms24043392] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Availability of artificial light and light-emitting devices have altered human temporal life, allowing 24-hour healthcare, commerce and production, and expanding social life around the clock. However, physiology and behavior that evolved in the context of 24 h solar days are frequently perturbed by exposure to artificial light at night. This is particularly salient in the context of circadian rhythms, the result of endogenous biological clocks with a rhythm of ~24 h. Circadian rhythms govern the temporal features of physiology and behavior, and are set to precisely 24 h primarily by exposure to light during the solar day, though other factors, such as the timing of meals, can also affect circadian rhythms. Circadian rhythms are significantly affected by night shift work because of exposure to nocturnal light, electronic devices, and shifts in the timing of meals. Night shift workers are at increased risk for metabolic disorder, as well as several types of cancer. Others who are exposed to artificial light at night or late mealtimes also show disrupted circadian rhythms and increased metabolic and cardiac disorders. It is imperative to understand how disrupted circadian rhythms alter metabolic function to develop strategies to mitigate their negative effects. In this review, we provide an introduction to circadian rhythms, physiological regulation of homeostasis by the suprachiasmatic nucleus (SCN), and SCN-mediated hormones that display circadian rhythms, including melatonin and glucocorticoids. Next, we discuss circadian-gated physiological processes including sleep and food intake, followed by types of disrupted circadian rhythms and how modern lighting disrupts molecular clock rhythms. Lastly, we identify how disruptions to hormones and metabolism can increase susceptibility to metabolic syndrome and risk for cardiovascular diseases, and discuss various strategies to mitigate the harmful consequences associated with disrupted circadian rhythms on human health.
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Rishi MA, Khosla S, Sullivan SS. Health advisory: melatonin use in children. J Clin Sleep Med 2023; 19:415. [PMID: 36239049 PMCID: PMC9892750 DOI: 10.5664/jcsm.10332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Affiliation(s)
| | - Seema Khosla
- North Dakota Center for Sleep, Fargo, North Dakota
| | - Shannon S. Sullivan
- Division of Pulmonary, Asthma, and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - for the Public Safety and the Public Awareness Advisory Committees of the American Academy of Sleep Medicine
- Indiana University School of Medicine, Indianapolis, Indiana
- North Dakota Center for Sleep, Fargo, North Dakota
- Division of Pulmonary, Asthma, and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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12
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Shimura A, Kanno T, Inoue T. Ultra-low-dose early night ramelteon administration for the treatment of delayed sleep-wake phase disorder: case reports with a pharmacological review. J Clin Sleep Med 2022; 18:2861-2865. [PMID: 35929592 PMCID: PMC9713914 DOI: 10.5664/jcsm.10188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 12/14/2022]
Abstract
Delayed sleep-wake phase disorder (DSWPD) is a common circadian sleep-wake phase disorders brings serious social impairment of the patients. Melatonin is the main medication option; however, it has not been approved in some countries, and over-the-counter melatonin is under poor quality control. The melatonin receptor agonist ramelteon might be a potential treatment option, but there are few reports regarding its use in DSWPD patients. Existing pharmacological and chronobiological studies suggest that an ultra-low dose of ramelteon in the early night is beneficial for DSWPD. Here, we present our clinical experience together with a pharmacological review and discussion. Twenty-three DSWPD patients, of whom 18 patients had a treatment history of a normal dose of ramelteon, were prescribed low-dose ramelteon (median: 0.571 mg, 1/14 of a tablet) to be taken in the early night (mean: 18:10). After the treatment, the mean sleep schedule was significantly advanced, and clinical symptoms were improved. CITATION Shimura A, Kanno T, Inoue T. Ultra-low-dose early night ramelteon administration for the treatment of delayed sleep-wake phase disorder: case reports with a pharmacological review. J Clin Sleep Med. 2022;18(12):2861-2865.
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Affiliation(s)
- Akiyoshi Shimura
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
- Department of Sleep and Psychiatry, Kanno Hospital, Saitama, Japan
- Neuropsychiatric Research Center, Tokyo, Japan
| | - Takashi Kanno
- Department of Sleep and Psychiatry, Kanno Hospital, Saitama, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
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Høier NK, Madsen T, Spira AP, Hawton K, Jennum P, Nordentoft M, Erlangsen A. Associations between treatment with melatonin and suicidal behavior: a nationwide cohort study. J Clin Sleep Med 2022; 18:2451-2458. [PMID: 35801338 PMCID: PMC9516579 DOI: 10.5664/jcsm.10118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Melatonin is often prescribed to patients with sleep disorders who are known to have elevated suicide risks, yet melatonin's association with suicidal behavior remains to be examined. We investigated whether individuals prescribed melatonin had higher rates of suicide and suicide attempts when compared to individuals who were not prescribed this drug, including both those with and without known mental disorders. METHODS A cohort design was applied to longitudinal, register data on all persons aged ≥ 10 years in Denmark during 2007-2016. Based on data from the National Prescription Registry, periods of being in treatment with melatonin were defined using information on the number of tablets and the daily defined dose. We calculated incidence rate ratios for suicide and suicide attempts, as identified in register records, comparing those in treatment with melatonin to those not in treatment. RESULTS Among 5,798,923 individuals, 10,577 (0.2%) were treated with melatonin (mean treatment length, 50 days) during the study period. Of those, 22 died by suicide and 134 had at least 1 suicide attempt. People in treatment with melatonin had a 4-fold higher rate of suicide (incidence rate ratio, 4.8; 95% CI, 3.0-7.5) and a 5-fold higher rate of suicide attempt (incidence rate ratio, 5.9; 95% CI, 4.4-8.0) than those not in treatment and when adjusting for sex and age group. CONCLUSIONS Treatment with melatonin was associated with suicide and suicide attempt. Although there are several possible explanations, attention to suicide risk is particularly warranted for people with mental comorbidity who are in treatment with melatonin. CITATION Høier NK, Madsen T, Spira AP, et al. Associations between treatment with melatonin and suicidal behavior: a nationwide cohort study. J Clin Sleep Med. 2022;18(10):2451-2458.
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Affiliation(s)
- Nikolaj Kjær Høier
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Trine Madsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Adam P. Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Keith Hawton
- Center for Suicide Research, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Poul Jennum
- Danish Center for Sleep Medicine, Rigshospitalet and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Marupuru S, Arku D, Campbell AM, Slack MK, Lee JK. Use of Melatonin and/on Ramelteon for the Treatment of Insomnia in Older Adults: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11175138. [PMID: 36079069 PMCID: PMC9456584 DOI: 10.3390/jcm11175138] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 11/19/2022] Open
Abstract
To investigate the efficacy of melatonin and/or ramelteon reporting sleep outcomes for older adults with chronic insomnia, a systematic review and a meta-analysis of PubMed, EMBASE, Cochrane library, International Pharmaceutical Abstracts, PsycINFO, science citation index, center for reviews and dissemination, CINAHL, grey literature and relevant sleep journal searches were conducted from 1 January 1990 to 20 June 2021. Randomized controlled trials and other comparative studies with melatonin and/or ramelteon use among older patients with chronic insomnia were included. Funnel plot and Egger’s test was used to determine publication bias. A forest plot was constructed to obtain a pooled standardized mean difference using either a fixed or random effects model for each of the two broad categories of sleep outcomes: objective and subjective. Of 5247 studies identified, 17 studies met the inclusion criteria for MA. Study sample size ranged from 10 to 829 with the mean age ≥55 years. There were significant improvements in total sleep time (objective), sleep latency and sleep quality (objective and subjective) for melatonin and/or ramelteon users compared with placebo. Sleep efficiency was not significantly different. The effects of these agents are modest but with limited safe treatment options for insomnia in older adults, these could be the drugs of choice.
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Attention Deficit Hyperactivity Disorder Medications and Sleep. Child Adolesc Psychiatr Clin N Am 2022; 31:499-514. [PMID: 35697398 DOI: 10.1016/j.chc.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep problems are common and often increase when initiating pharmacotherapy for ADHD. Stimulants are commonly associated with delayed sleep onset/insomnia although nonstimulants can be associated with daytime sleepiness. There is a wide variability in severity and duration of sleep effects, but most effects are mild and improve over time. Although sleep problems occur in all age groups, preschoolers and adolescents appear to be more vulnerable to adverse effects on sleep than adults and children. Interventions to improve sleep include behavioral therapy, changing dose schedules or formulations, and adding a sleep-promoting agent such as melatonin.
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16
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Bishop-Freeman SC, Young KA, Labay LM, Beuhler MC, Hudson JS. Melatonin Supplementation in Undetermined Pediatric Deaths. J Anal Toxicol 2022; 46:808-816. [PMID: 35639879 DOI: 10.1093/jat/bkac033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/12/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Since 2015, the North Carolina Office of the Chief Medical Examiner has investigated seven deaths of infants and toddlers, ages 2 months to 3 years, with exogenous melatonin detected upon toxicological analysis. Melatonin concentrations ranged from 3-1400 ng/mL in postmortem whole blood. While the cause and the manner of all seven deaths were classified as undetermined, the analytical findings are noteworthy. Melatonin is generally considered a safe, natural product appearing in many over-the-counter supplements geared towards young children to facilitate calmness and improve sleep. Melatonin is a neurohormone, which regulates not only circadian rhythms and natural sleep, but other physiological functions. Endogenous melatonin production, derived from essential amino acid metabolism, does not begin until pineal gland maturation at around three months of age with concentrations in plasma peaking during periods of darkness at approximately 0.2 ng/mL. Administering commercially available melatonin supplements to infants results in levels orders of magnitude greater than endogenous sources which should not be assumed to be safe just because of its endogenous nature. The finding of exogenous concentrations in some postmortem pediatric cases warrants attention. Several topics of interest surrounding these postmortem melatonin findings will be considered, such as minimal regulatory control over commercial products as well as the potential impact on hazardous sleeping conditions. This manuscript will outline the physiological effects of melatonin and detail the case studies from the NC medical examiner system. Forensic toxicology laboratories should consider including melatonin at exogenous concentrations in their testing schemes for appropriate postmortem infant and toddler cases.
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Affiliation(s)
- Sandra C Bishop-Freeman
- North Carolina Office of Chief Medical Examiner, 4312 District Dr. Raleigh, NC 27607, USA.,University of North Carolina, Department of Pathology and Laboratory Medicine, Chapel Hill, NC 27514, USA
| | - Kerry A Young
- North Carolina Office of Chief Medical Examiner, 4312 District Dr. Raleigh, NC 27607, USA
| | | | - Michael C Beuhler
- Carolinas Poisons Control, 5000 Airport Center Pkwy Suite B Charlotte, NC 28208, USA
| | - Jason S Hudson
- North Carolina Office of Chief Medical Examiner, 4312 District Dr. Raleigh, NC 27607, USA.,University of North Carolina, Department of Pathology and Laboratory Medicine, Chapel Hill, NC 27514, USA
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17
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Anghel L, Baroiu L, Popazu CR, Pătraș D, Fotea S, Nechifor A, Ciubara A, Nechita L, Mușat CL, Stefanopol IA, Tatu AL, Ciubara AB. Benefits and adverse events of melatonin use in the elderly (Review). Exp Ther Med 2022; 23:219. [PMID: 35126722 PMCID: PMC8796282 DOI: 10.3892/etm.2022.11142] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 12/11/2022] Open
Abstract
Melatonin is a hormone secreted by the pineal gland in accordance with the circadian rhythm when the light level decreases. Reduction of melatonin secretion with age may be associated with physiological aging in neurodegenerative diseases by affecting the suprachiasmatic nucleus or of the neuronal pathways of transmission to the pineal gland. A significant decrease in melatonin synthesis has been reported in various disorders and diseases, including cardiovascular diseases, metabolic disorders (particularly diabetes type 2), cancer and endocrine diseases. In addition to the fact, that melatonin is a sleep inducer, it also exerts cytoprotective properties as an antioxidant and free radical scavenger. The therapeutic role of melatonin has been demonstrated in sleep disorders, eye damage and cardiovascular disease. The association between melatonin and β-blockers has had a positive impact on sleep disorders in clinical trials. Previous studies have reported the anti-inflammatory effect of melatonin by adjusting levels of pro-inflammatory cytokines, including interleukin (IL)-6, IL-1β and tumor necrosis factor-α. Melatonin treatment has been demonstrated to decrease IL-6 and IL-10 expression levels and efficiently attenuate T-cell proliferation. Currently, there is an inconsistency of scientific data regarding the lowest optimal dose and safety of melatonin for long-term use. The aim of the present review was to summarize the evidence on the role of melatonin in various clinical conditions and highlight the future research in this area.
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Affiliation(s)
- Lucreția Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania
| | - Corina Rișcă Popazu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania
| | - Diana Pătraș
- Internal Medicine Department, St. Andrew The Apostle Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Silvia Fotea
- Clinical Medical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania.,Multidisciplinary Integrated Center of Dermatological Interface Research, 'Dunărea de Jos' University, 800008 Galați, Romania
| | - Anamaria Ciubara
- Clinical Medical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania
| | - Luiza Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania
| | - Carmina Liana Mușat
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania
| | - Ioana Anca Stefanopol
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania
| | - Alin Laurențiu Tatu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania.,Multidisciplinary Integrated Center of Dermatological Interface Research, 'Dunărea de Jos' University, 800008 Galați, Romania.,Research Center in The Field of Medical and Pharmaceutical Sciences, 'Dunărea de Jos' University, 800008 Galați, Romania
| | - Alexandru Bogdan Ciubara
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, 800008 Galați, Romania
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18
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Abstract
Melatonin is a hormonal product of the pineal gland, a fact that is often forgotten. Instead it is promoted as a dietary supplement that will overcome insomnia, as an antioxidant and as a prescription only drug in most countries outside the United States of America and Canada. The aim of this review is to step back and highlight what we know about melatonin following its discovery 60 years ago. What is the role of endogenous melatonin; what does melatonin do to sleep, body temperature, circadian rhythms, the cardiovascular system, reproductive system, endocrine system and metabolism when administered to healthy subjects? When used as a drug/dietary supplement, what safety studies have been conducted? Can we really say melatonin is safe when it has not been systematically studied and many studies show interactions with a wide range of physiological processes? Finally the results of studies investigating the efficacy of melatonin as a drug to alleviate insomnia are critically evaluated. In summary, melatonin is an endogenous pineal gland hormone with specific physiological functions in animals and humans, with its primary role in humans to maintain synchrony of sleep with the day/night cycle. When administered as a drug it affects a wide range of physiological systems and has clinically important drug interactions. With respect to efficacy for treating sleep disorders, melatonin can advance the time of sleep onset but the effect is modest and variable. In children with neurodevelopmental disabilities melatonin appears to have the greatest impact on sleep onset but little effect on sleep efficiency.
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Affiliation(s)
- David J Kennaway
- Robinson Research Institute and Adelaide School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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19
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Lim S, Park S, Koyanagi A, Yang JW, Jacob L, Yon DK, Lee SW, Kim MS, Il Shin J, Smith L. Effects of exogenous melatonin supplementation on health outcomes: An umbrella review of meta-analyses based on randomized controlled trials. Pharmacol Res 2022; 176:106052. [PMID: 34999224 DOI: 10.1016/j.phrs.2021.106052] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 12/15/2022]
Abstract
Various melatonin supplementations have been developed to improve health outcomes in various clinical conditions. Thus, we sought to evaluate and summarize the effect of melatonin treatments in clinical settings for health outcomes. We searched PubMed/Medline, Embase, and Cochrane Library from inception to 4 February 2021. We included meta-analyses of randomized controlled trials investigating the melatonin intervention for any health outcome. Based on the different effect sizes of each meta-analysis, we calculated random models' standardized mean differences or risk ratios. We observed robust evidence supported by statistical significance with non-considerable heterogeneity between studies for sleep-related problems, cancer, surgical patients, and pregnant women. Patients with sleep disorder, sleep onset latency (SMD 0.33, 95% CI: 0.10 - 0.56, P < 0.01) were significantly improved whereas no clear evidence was shown with sleep efficiency (1.10, 95% CI: -0.26 to 2.45). The first analgesic requirement time (SMD 5.81, 95% CI: 2.57-9.05, P < 0.001) of surgical patients was distinctly improved. Female patients under artificial reproductive technologies had significant increase in the top-quality embryos (SMD 0.53, 95% CI: 0.27 - 0.79, P < 0.001), but no statistically clear evidence was found in the live birth rate (SMD 1.20, 95% CI: 0.83 - 1.72). Survival at one year (RR 1.90, 95% CI: 1.28 - 2.83, P < 0.005) significantly increased with cancer patients. Research on melatonin interventions to treat clinical symptoms and sleep problems among diverse health conditions was identified and provided considerable evidence. Future well-designed randomized clinical trials of high quality and subgroup quantitative analyses are essential.
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Affiliation(s)
- Soojin Lim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seoyeon Park
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ai Koyanagi
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain
| | - Jae Won Yang
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Dong Keon Yon
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Min Seo Kim
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Lee Smith
- Cambridge Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
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20
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Cardinali DP, Brown GM, Pandi-Perumal SR. Melatonin's Benefits and Risks as a Therapy for Sleep Disturbances in the Elderly: Current Insights. Nat Sci Sleep 2022; 14:1843-1855. [PMID: 36267165 PMCID: PMC9578490 DOI: 10.2147/nss.s380465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/03/2022] [Indexed: 01/19/2023] Open
Abstract
Aging is accompanied by circadian changes, including disruptive alterations in the sleep/wake cycle, as well as the beginning of low-degree inflammation ("inflammaging"), a scenario that leads to several chronic illnesses, including cancer, and metabolic, cardiovascular, and neurological dysfunctions. As a result, any effective approach to healthy aging must consider both the correction of circadian disturbance and the control of low-grade inflammation. One of the most important prerequisites for healthy aging is the preservation of robust circadian rhythmicity (particularly of the sleep/wake cycle). Sleep disturbance disrupts various activities in the central nervous system, including waste molecule elimination. Melatonin is a chemical with extraordinary phylogenetic conservation found in all known aerobic creatures whose alteration plays an important role in sleep changes with aging. Every day, the late afternoon/nocturnal surge in pineal melatonin helps to synchronize both the central circadian pacemaker found in the hypothalamic suprachiasmatic nuclei (SCN) and a plethora of peripheral cellular circadian clocks. Melatonin is an example of an endogenous chronobiotic substance that can influence the timing and amplitude of circadian rhythms. Moreover, melatonin is also an excellent anti-inflammatory agent, buffering free radicals, down-regulating proinflammatory cytokines, and reducing insulin resistance, among other things. We present both scientific and clinical evidence that melatonin is a safe drug for treating sleep disturbances in the elderly.
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Affiliation(s)
- Daniel P Cardinali
- Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Gregory M Brown
- Molecular Brain Science Research Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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21
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Falco C, Barton C. Melatonin administration for sleep disorders in traumatic brain injury: A review of the literature. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Bueno APR, Savi FM, Alves IA, Bandeira VAC. Regulatory aspects and evidences of melatonin use for sleep disorders and insomnia: an integrative review. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:732-742. [PMID: 34550191 DOI: 10.1590/0004-282x-anp-2020-0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Insomnia is a sleep disorder characterized by difficulty of falling asleep or maintaining sleep, which affects different age groups. Currently, melatonin is used as a therapeutic treatment in cases of insomnia in children, adults, and elderly people. OBJECTIVE To evaluate the effectiveness of melatonin in sleep disorders, its dosage, potential adverse effects, as well as labeling laws and regulations in Brazil. METHODS This integrative review was carried out using the Cochrane Library, Medline (Pubmed), and Science Direct databases. Twenty-five articles and three documents available on the Brazilian Society of Endocrinology and Metabology (SBEM) and National Health Surveillance Agency (ANVISA) websites published between 2015 and 2020 were selected to be evaluated in full. RESULTS It was found that in most of the selected articles the use of melatonin reduces sleep latency. The effective melatonin doses varied according to each age group, from 0.5 to 3 mg in children, 3 to 5 mg in adolescents, 1 to 5 mg in adults, and 1 to 6 mg in elderly people. Side effects are mild when taking usual doses. In Brazil, no registered drug and current regulation on the use and marketing of melatonin has been identified. CONCLUSION The use of melatonin is an alternative therapy that can be used for sleeping disorders. According to the evidences found, it did not demonstrate toxicity or severe side effects, nor dependence even when administered at high doses, suggesting that it is a safe medication to treat patients of different ages suffering from sleeping disorders.
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Affiliation(s)
- Ana Paula Rosinski Bueno
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Departamento de Ciências da Vida, Ijuí RS, Brazil
| | - Flávia Medeiros Savi
- Queensland University of Technology, Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation, Kelvin Grove, Australia
| | - Izabel Almeida Alves
- Universidade Federal da Bahia, Faculdade de Farmácia, Departamento do Medicamento, Salvador BA, Brazil
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23
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Melatonin Increases Life Span, Restores the Locomotor Activity, and Reduces Lipid Peroxidation (LPO) in Transgenic Knockdown Parkin Drosophila melanogaster Exposed to Paraquat or Paraquat/Iron. Neurotox Res 2021; 39:1551-1563. [PMID: 34339012 DOI: 10.1007/s12640-021-00397-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
Parkinson's disease (PD) is a complex progressive neurodegenerative disorder involving impairment of bodily movement caused by the specific destruction of dopaminergic (DAergic) neurons. Mounting evidence suggests that PD might be triggered by an interplay between environmental neurotoxicants (e.g., paraquat, PQ), heavy metals (e.g., iron), and gene alterations (e.g., PARKIN gene). Unfortunately, there are no therapies currently available that protect, slow, delay, or prevent the progression of PD. Melatonin (Mel, N-acetyl-5-methoxy tryptamine) is a natural hormone with pleiotropic functions including receptor-independent pathways which might be useful in the treatment of PD. Therefore, as a chemical molecule, it has been shown that Mel prolonged the lifespan and locomotor activity, and reduced lipid peroxidation (LPO) in wild-type Canton-S flies exposed to PQ, suggesting antioxidant and neuroprotective properties. However, it is not yet known whether Mel can protect or prevent the genetic model parkin deficient in flies against oxidative stress (OS) stimuli. Here, we show that Mel (0.5, 1, 3 mM) significantly extends the life span and locomotor activity of TH > parkin-RNAi/ + Drosophila melanogaster flies (> 15 days) compared to untreated flies. Knock-down (K-D) parkin flies treated with PQ (1 mM) or PQ (1 mM)/iron (1 mM) significantly diminished the survival index and climbing abilities (e.g., 50% of flies were dead and locomotor impairment by days 4 and 3, respectively). Remarkably, Mel reverted the noxious effect of PQ or PQ/iron combination in K-D parkin. Indeed, Mel protects TH > parkin-RNAi/ + Drosophila melanogaster flies against PQ- or PQ/iron-induced diminish survival, locomotor impairment, and LPO (e.g., 50% of flies were death and locomotor impairment by days 6 and 9, respectively). Similarly, Mel prevented K-D parkin flies against both PQ and PQ/iron. Taken together, these findings suggest that Mel can be safely used as an antioxidant and neuroprotectant agent against OS-stimuli in selective individuals at risk to suffer early-onset Parkinsonism and PD.
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24
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Moroni I, Garcia-Bennett A, Chapman J, Grunstein RR, Gordon CJ, Comas M. Pharmacokinetics of exogenous melatonin in relation to formulation, and effects on sleep: A systematic review. Sleep Med Rev 2021; 57:101431. [PMID: 33549911 DOI: 10.1016/j.smrv.2021.101431] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022]
Abstract
There is conflicting evidence on the clinical efficacy of exogenous melatonin for the treatment of sleep disorders. This may be due to differences in the pharmacokinetic (PK) properties of melatonin formulations used in clinical trials. The aim of this systematic review was to understand the relationship between melatonin formulations and PK parameters and, where possible, the effects on sleep outcomes. To this purpose, we conducted a systematic review and nineteen papers were included. The studies included three melatonin transdermal formulation, thirteen oral formulations, one topical, two buccal, two intravenous and two nasogastric formulations. Seven studies investigated the effect of the melatonin formulation on sleep and six of them found a significant improvement in one or more sleep parameters. The potential for an improved controlled release formulation that delays maximum concentration (Cmax) was identified. The different formulations and doses affect melatonin PK, suggesting that treatment efficacy maybe affected. Based on the current evidence, we are unable to provide recommendations of specific melatonin formulations and PK parameters for specific sleep disorders. Future studies should systematically investigate how different PK parameters of melatonin formulations affect efficacy treatment of sleep as well as circadian disorders.
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Affiliation(s)
- Irene Moroni
- Department of Molecular Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alfonso Garcia-Bennett
- Department of Molecular Sciences, Macquarie University, Sydney, NSW, Australia; ARC Centre for Nanoscale BioPhotonics, Macquarie University, Sydney, NSW, Australia
| | - Julia Chapman
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Sydney Local Health District, Sydney, NSW, Australia
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Sydney Local Health District, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Christopher J Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | - Maria Comas
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.
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25
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Mantle D, Smits M, Boss M, Miedema I, van Geijlswijk I. Efficacy and safety of supplemental melatonin for delayed sleep-wake phase disorder in children: an overview. Sleep Med X 2020; 2:100022. [PMID: 33870175 PMCID: PMC8041131 DOI: 10.1016/j.sleepx.2020.100022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 02/03/2023] Open
Abstract
Delayed sleep–wake phase disorder (DSPD) is the most frequently occurring intrinsic circadian rhythm sleep–wake disorder, with the highest prevalence in adolescence. Melatonin is the first-choice drug treatment. However, to date melatonin (in a controlled-release formulation) is only authorised for the treatment of insomnia in children with autism or Smiths-Magenis syndrome. Concerns have been raised with respect to the safety and efficacy of melatonin for more general use in children, as melatonin has not undergone the formal safety testing required for a new drug, especially long-term safety in children. Melatonin is known to have profound effects on the reproductive systems of rodents, sheep and primates, as well as effects on the cardiovascular, immune and metabolic systems. The objective of the present article was therefore to establish the efficacy and safety of exogenous melatonin for use in children with DSPD, based on in vitro, animal model and clinical studies by reviewing the relevant literature in the Medline database using PubMed. Acute toxicity studies in rats and mice showed toxic effects only at extremely high melatonin doses (>400 mg/kg), some tens of thousands of times more than the recommended dose of 3–6 mg in a person weighing 70 kg. Longer-term administration of melatonin improved the general health and survival of ageing rats or mice. A full range of in vitro/in vivo genotoxicity tests consistently found no evidence that melatonin is genotoxic. Similarly long term administration of melatonin in rats or mice did not have carcinogenic effects, or negative effects on cardiovascular, endocrine and reproductive systems. With regard to clinical studies, in 19 randomised controlled trials comprising 841 children and adolescents with DSPD, melatonin treatment (usually of 4 weeks duration) consistently improved sleep latency by 22–60 min, without any serious adverse effects. Similarly, 17 randomised controlled trials, comprising 1374 children and adolescents, supplementing melatonin for indications other than DSPD, reported no relevant adverse effects. In addition, 4 long-term safety studies (1.0–10.8 yr) supplementing exogenous melatonin found no substantial deviation of the development of children with respect to sleep quality, puberty development and mental health scores. Finally, post-marketing data for an immediate-release melatonin formulation (Bio-melatonin), used in the UK since 2008 as an unlicensed medicine for sleep disturbance in children, recorded no adverse events to date on sales of approximately 600,000 packs, equivalent to some 35 million individual 3 mg tablet doses (MHRA yellow card adverse event recording scheme). In conclusion, evidence has been provided that melatonin is an efficacious and safe chronobiotic drug for the treatment of DSPD in children, provided that it is administered at the correct time (3–5 h before endogenous melatonin starts to rise in dim light (DLMO)), and in the correct (minimal effective) dose. As the status of circadian rhythmicity may change during long-time treatment, it is recommended to stop melatonin treatment at least once a year (preferably during the summer holidays). Melatonin improves sleep onset without serious adverse effects in youths with DSPD. Change th text after the fourth bullet into: Melatonin is an efficacious and safe chronobiotic drug for the treatment of DSPD in youths. Melatonin for indications other than DSPD, dose not cause relevant adverse effects. Long term melatonin treatment does not impair sleep, puberty, and mental health. Melatonin is an efficacious and safe chronobiotic drug for the treatment of DSPD in youths. Melatonin should be administered at the correct time and in the minimal effective dose.
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Affiliation(s)
| | - Marcel Smits
- Multidisciplinary Expertise Centre for Sleep-Wake Disorders and Chronobiology, Gelderse Valley Hospital Ede, The Netherlands
| | - Myrthe Boss
- Multidisciplinary Expertise Centre for Sleep-Wake Disorders and Chronobiology, Gelderse Valley Hospital Ede, The Netherlands
| | - Irene Miedema
- Multidisciplinary Expertise Centre for Sleep-Wake Disorders and Chronobiology, Gelderse Valley Hospital Ede, The Netherlands
| | - Inge van Geijlswijk
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, and Faculty of Veterinary Medicine, Pharmacy Department Utrecht University, Utrecht, The Netherlands
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26
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Boccanegra B, Verhaart IEC, Cappellari O, Vroom E, De Luca A. Safety issues and harmful pharmacological interactions of nutritional supplements in Duchenne muscular dystrophy: considerations for Standard of Care and emerging virus outbreaks. Pharmacol Res 2020; 158:104917. [PMID: 32485610 PMCID: PMC7261230 DOI: 10.1016/j.phrs.2020.104917] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022]
Abstract
At the moment, little treatment options are available for Duchenne muscular dystrophy (DMD). The absence of the dystrophin protein leads to a complex cascade of pathogenic events in myofibres, including chronic inflammation and oxidative stress as well as altered metabolism. The attention towards dietary supplements in DMD is rapidly increasing, with the aim to counteract pathology-related alteration in nutrient intake, the consequences of catabolic distress or to enhance the immunological response of patients as nowadays for the COVID-19 pandemic emergency. By definition, supplements do not exert therapeutic actions, although a great confusion may arise in daily life by the improper distinction between supplements and therapeutic compounds. For most supplements, little research has been done and little evidence is available concerning their effects in DMD as well as their preventing actions against infections. Often these are not prescribed by clinicians and patients/caregivers do not discuss the use with their clinical team. Then, little is known about the real extent of supplement use in DMD patients. It is mistakenly assumed that, since compounds are of natural origin, if a supplement is not effective, it will also do no harm. However, supplements can have serious side effects and also have harmful interactions, in terms of reducing efficacy or leading to toxicity, with other therapies. It is therefore pivotal to shed light on this unclear scenario for the sake of patients. This review discusses the supplements mostly used by DMD patients, focusing on their potential toxicity, due to a variety of mechanisms including pharmacodynamic or pharmacokinetic interactions and contaminations, as well as on reports of adverse events. This overview underlines the need for caution in uncontrolled use of dietary supplements in fragile populations such as DMD patients. A culture of appropriate use has to be implemented between clinicians and patients' groups.
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Affiliation(s)
- Brigida Boccanegra
- Unit of Pharmacology, Department of Pharmacy and Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Ingrid E C Verhaart
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands; Duchenne Parent Project, the Netherlands
| | - Ornella Cappellari
- Unit of Pharmacology, Department of Pharmacy and Drug Sciences, University of Bari Aldo Moro, Bari, Italy
| | - Elizabeth Vroom
- Duchenne Parent Project, the Netherlands; World Duchenne Organisation (UPPMD), the Netherlands
| | - Annamaria De Luca
- Unit of Pharmacology, Department of Pharmacy and Drug Sciences, University of Bari Aldo Moro, Bari, Italy.
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Adverse Events Associated with Melatonin for the Treatment of Primary or Secondary Sleep Disorders: A Systematic Review. CNS Drugs 2019; 33:1167-1186. [PMID: 31722088 DOI: 10.1007/s40263-019-00680-w] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Melatonin is widely available either on prescription for the treatment of sleep disorders or as an over-the-counter dietary supplement. Melatonin has also recently been licensed in the UK for the short-term treatment of jetlag. Little is known about the potential for adverse events (AEs), in particular AEs resulting from long-term use. Concern has been raised over the possible risks of exposure in certain populations including pre-adolescent children and patients with epilepsy or asthma. OBJECTIVES The aim of this systematic review was to assess the evidence for AEs associated with short-term and longer-term melatonin treatment for sleep disorders. METHODS A literature search of the PubMed/Medline database and Google Scholar was conducted to identify randomised, placebo-controlled trials (RCTs) of exogenous melatonin administered for primary or secondary sleep disorders. Studies were included if they reported on both the types and frequencies of AEs. Studies of pre-term infants, studies of < 1 week in duration or involving single doses of melatonin and studies in languages other than English were excluded. Findings from open-label studies that raised concerns relating to AE reports in patients were also examined. Studies were assessed for quality of reporting against the Consolidated Standards of Reporting Trials (CONSORT) checklist and for risk of bias against the Cochrane Collaboration risk-of-bias criteria. RESULTS 37 RCTs met criteria for inclusion. Daily melatonin doses ranged from 0.15 mg to 12 mg. Subjects were monitored for up to 29 weeks, but most studies were of much shorter duration (4 weeks or less). The most frequently reported AEs were daytime sleepiness (1.66%), headache (0.74%), other sleep-related AEs (0.74%), dizziness (0.74%) and hypothermia (0.62%). Very few AEs considered to be serious or of clinical significance were reported. These included agitation, fatigue, mood swings, nightmares, skin irritation and palpitations. Most AEs either resolved spontaneously within a few days with no adjustment in melatonin, or immediately upon withdrawal of treatment. Melatonin was generally regarded as safe and well tolerated. Many studies predated publication of the CONSORT checklist and consequently did not conform closely to the guidelines. Similarly, only eight studies were judged 'good' overall with respect to the Cochrane risk-of-bias criteria. Of the remaining papers, 16 were considered 'fair' and 13 'poor' but publication of almost half of the papers preceded that of the earliest version of the guidelines. CONCLUSION Few, generally mild to moderate, AEs were associated with exogenous melatonin. No AEs that were life threatening or of major clinical significance were identified. The scarcity of evidence from long-term RCTs, however, limits the conclusions regarding the safety of continuous melatonin therapy over extended periods. There are insufficient robust data to allow a meaningful appraisal of concerns that melatonin may result in more clinically significant adverse effects in potentially at-risk populations. Future studies should be designed to comply with appropriate quality standards for RCTs, which most past studies have not.
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Yurova MN, Tyndyk ML, Popovich IG, Golubev AG, Anisimov VN. Gender Specificity of the Effect of Neonatal Melatonin Administration on Lifespan and Age-Associated Pathology in 129/Sv Mice. ADVANCES IN GERONTOLOGY 2019. [DOI: 10.1134/s2079057019030184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Visser HE, Dees DD, Millichamp NJ, Vallone LV, Scott EM. Effect of orally administered melatonin on intraocular pressure of ophthalmologically normal dogs. Am J Vet Res 2019; 80:410-415. [PMID: 30919670 DOI: 10.2460/ajvr.80.4.410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effect of orally administered melatonin on the intraocular pressure (IOP) of ophthalmologically normal dogs. ANIMALS 20 ophthalmologically normal dogs (40 eyes). PROCEDURES In a randomized crossover study, each dog received a 7-day regimen of melatonin (0.1 to 0.2 mg/kg, PO, q 12 h) and a placebo (150 mg of lactose powder in a capsule, PO, q 12 h), with a 7-day washout period between treatment regimens. Rebound tonometry was used to measure the IOP in both eyes of each dog 5 times at 2-hour intervals on days 0 (before administration of the first dose), 2, 4, and 7 (after administration of the last dose) of each treatment period. Repeated-measures ANOVA was used to evaluate the effects of treatment, day, and IOP measurement time within day on IOP. RESULTS Intraocular pressure was not significantly associated with treatment but was associated with day and the interaction between day and IOP measurement time within day. The mean ± SD IOP was 14.26 ± 2.95 and 14.34 ± 2.69 mm Hg for the melatonin and placebo regimens, respectively. Within each treatment period, the mean IOP tended to decrease from day 0 to 7 as well as within each day, which was attributed to the dogs becoming acclimated to the study protocol and natural diurnal variations in IOP. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that oral administration of melatonin (0.1 to 0.2 mg/kg, q 12 h for 7 d) did not significantly affect the IOP of ophthalmologically normal dogs.
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Melatonin: A New-Generation Therapy for Reducing Chronic Pain and Improving Sleep Disorder-Related Pain. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1099:229-251. [DOI: 10.1007/978-981-13-1756-9_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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