1
|
Veyrier M, Ariouat I, Jacob A, Trout H, Bloch V, Delavest M, Bellivier F, Geoffroy PA. Use of immediate release melatonin in psychiatry: BMI impacts the daily-dose. Encephale 2020; 47:96-101. [PMID: 33349460 DOI: 10.1016/j.encep.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/28/2020] [Accepted: 08/08/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE There is a growing interest in psychiatry regarding melatonin use both for its soporific and chronobiotic effects. This study aimed to evaluate factors impacting the daily-dose. METHODS In a university department of psychiatry in Paris (France), we conducted a posteriori naturalistic observational study from April 03, 2017 to January 31, 2018. We assessed links between sociodemographic and clinical characteristics and daily dose of melatonin (the daily-dose of melatonin initiation and the daily-dose at Hospital discharge). A survey of drug interactions was performed regarding metabolic inducers and inhibitors of the cytochrome P450 1A2. RESULTS Forty patients were included and treated with immediate-release melatonin. For patients with no history of melatonin use, the initiation dose of was 2 or 4mg, with no effects of age, weight, BMI, melatonin indication, cause of hospitalization. We found that higher discharge dose was associated with higher BMI (P=0.036) and more reevaluations of melatonin dose (P=0.00019). All patients with a moderate inducer (n=3, here lansoprazole) were significantly more associated with the discontinuation melatonin group (P=0.002). CONCLUSION The BMI and the number of reevaluations impact the daily dose of melatonin. Two mechanisms may explain that BMI may need higher doses: (i) melatonin diffuses into the fat mass, (ii) the variant 24E on melatonin receptor MT2, more frequent in obese patients, leads to a decrease of the receptor signal.
Collapse
Affiliation(s)
- M Veyrier
- Service Pharmacie, AP-HP, GH Saint-Louis-Lariboisière-F. Widal, 75475 Paris cedex 10, France.
| | - I Ariouat
- Service Pharmacie, AP-HP, GH Saint-Louis-Lariboisière-F. Widal, 75475 Paris cedex 10, France
| | - A Jacob
- Service Pharmacie, AP-HP, GH Saint-Louis-Lariboisière-F. Widal, 75475 Paris cedex 10, France; Iserm U1144 optimisation thérapeutique en neuropsychopharmacologie, université Paris Descartes, université Paris Diderot, université Sorbonne Paris Cité, Paris, France
| | - H Trout
- Service Pharmacie, AP-HP, GH Saint-Louis-Lariboisière-F. Widal, 75475 Paris cedex 10, France
| | - V Bloch
- Service Pharmacie, AP-HP, GH Saint-Louis-Lariboisière-F. Widal, 75475 Paris cedex 10, France; Iserm U1144 optimisation thérapeutique en neuropsychopharmacologie, université Paris Descartes, université Paris Diderot, université Sorbonne Paris Cité, Paris, France
| | - M Delavest
- Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis-Lariboisière-F. Widal, 75475 Paris cedex 10, France
| | - F Bellivier
- Iserm U1144 optimisation thérapeutique en neuropsychopharmacologie, université Paris Descartes, université Paris Diderot, université Sorbonne Paris Cité, Paris, France; Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis-Lariboisière-F. Widal, 75475 Paris cedex 10, France
| | - P A Geoffroy
- Iserm U1144 optimisation thérapeutique en neuropsychopharmacologie, université Paris Descartes, université Paris Diderot, université Sorbonne Paris Cité, Paris, France; Département de Psychiatrie et de Médecine Addictologique, AP-HP, GH Saint-Louis-Lariboisière-F. Widal, 75475 Paris cedex 10, France.
| |
Collapse
|