Melatonin

Melatonin Overview

Melatonin is a hormone involved in regulating the normal 24-hour cycles of the body, known as circadian rhythms. Blood levels of this hormone are low during the day and increase during the night.

Melatonin has many potential uses. Some researchers have found that melatonin may help with sleep problems and jet lag.

Made by the pineal gland in the brain, melatonin helps control your daily sleep-wake cycles. Your body’s internal clock (also known as your circadian rhythm) influences how much melatonin the pineal gland makes, and so does the amount of light that you’re exposed to each day. Typically, melatonin levels start to rise in the mid-to-late evening, after the sun has set. They stay elevated for most of the night while you’re in the dark. Then, they drop in the early morning as the sun rises, causing you to awaken.

Melatonin and Multiple Sclerosis (MS)

For many years debates have ensued about melatonin and MS patients utilizing melatonin supplements available over the counter.

Research has suggested that melatonin may increase risks of disease activity while contradictory research suggests melatonin usage in MS patients may have protective properties.

Studies of melatonin and MS stretches back from recent to over 20 years ago. Patients considering melatonin supplementation should only consider usage towards sleeping disorders at this point in time.

A sleep clinic and/or other mechanisms of managing sleeping problems should be pursued before ever considering melatonin supplementation.  Additionally before considering melatonin supplementation a very serious dialog should take place with your healthcare team.

Advice in melatonin supplementation from other patients should not be considered as supporting information.  Each individual has differing physiology and more research needs to take place to understand if and/or what melatonin has a role in MS.

Melatonin and Multiple Sclerosis Research

Dietary Supplements

When using dietary supplements, keep in mind the following:

• Like conventional medicines, dietary supplements may cause side effects, trigger allergic reactions, or interact with prescription and nonprescription medicines or other supplements you might be taking. A side effect or interaction with another medicine or supplement may make other health conditions worse. Always tell your doctor or pharmacist about all dietary supplements you are taking.
• The way dietary supplements are manufactured may not be standardized. Because of this, how well they work or any side effects they cause may differ among brands or even within different lots of the same brand. The form of supplement that you buy in health food or grocery stores may not be the same as the form used in research.
• Other than for vitamins and minerals, the long-term effects of most dietary supplements are not known.
• Don’t be seduced by low prices. While you may see what appears to be a low priced source of a supplement on a TV shopping channel, the Internet, or in a warehouse store, you aren’t always guaranteed that a product delivers the dosage listed on the label. While there are many reputable brands sold these ways, you need to be an informed shopper.
• Check expiration dates. Sometimes a supplement will come with a really low price tag because it’s coming up on its expiration date and needs to be sold quickly. So, check the label date. If the “sell by” or expiration date gives you enough time to use the product, it could be a good deal. But if there’s no expiration date, it’s very likely that the supplement dosage isn’t as high as what’s listed on the label.
• Ask questions before you buy. Make sure that any supplement you purchase is independently tested to ensure that it meets the dosage listed on the label.

Multiple Sclerosis is often an extremely complex health condition.  Changes in management of MS should always be discussed with your health care team accordingly before making any alterations to life with MS.

Dosing

Because it is not categorized as a drug, synthetic melatonin is made in factories that are not regulated. Listed doses may not be controlled or accurate, meaning the amount of melatonin in a pill you take may not be the amount listed on the package. Most commercial products are offered at dosages that cause melatonin levels in the blood to rise to much higher levels than are naturally produced in the body. Taking a typical dose (1 to 3 mg) may elevate your blood melatonin levels to 1 to 20 times normal.

For melatonin to be helpful, the correct dosage, method and time of day it is taken must be appropriate to the sleep problem. Taking it at the “wrong” time of day may reset your biological clock in an undesirable direction. How much to take, when to take it, and melatonin’s effectiveness, if any, for particular sleep disorders is only beginning to be understood.

While there are real concerns about the widespread use of melatonin sold as a consumer product, there have not been any reported cases of proven toxicity or overdose. If you are concerned about the correct melatonin dosage for you, talk to your health care profesional.

Multiple Sclerosis is often an extremely complex health condition.  Changes in management of MS should always be discussed with your health care team accordingly before making any alterations to life with MS.

Warnings

Melatonin supplements can negatively interact with many different medications, so be sure to check with your doctor before taking the sleep-inducing aid.

People commonly make the mistake of assuming that taking higher doses of melatonin will lead to better sleep. But the opposite is true: Too much taken at once can cause headaches, nausea, dizziness, or irritability, all of which can disrupt your sleep. So talk to your doctor, who may suggest these dosage guidelines:

Medication Interactions

• Melatonin might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking melatonin along with sedative medications might cause too much sleepiness. Some sedative medications include clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), and others.
• Birth control pills (Contraceptive drugs) interact with melatonin
  The body makes melatonin. Birth control pills seem to increase how much melatonin the body makes. Taking melatonin along with birth control pills might cause too much melatonin to be in the body. Some birth control pills include ethinyl estradiol and levonorgestrel (Triphasil), ethinyl estradiol and norethindrone (Ortho-Novum 1/35, Ortho-Novum 7/7/7), and others.
• Caffeine interact with melatonin
  Caffeine might decrease melatonin levels in the body. Taking melatonin along with caffeine might decrease the effectiveness of melatonin supplements.
• Fluvoxamine (Luvox) interact with melatonin
  Taking fluvoxamine (Luvox) can increase the amount of melatonin that the body absorbs. Taking melatonin along with fluvoxamine (Luvox) might increase the effects and side effects of melatonin.
• Medications for diabetes (Antidiabetes drugs) interact with melatonin
  Melatonin might increase blood sugar. Diabetes medications are used to lower blood sugar. By increasing blood sugar, melatonin might decrease the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.
• Medications that decrease the immune system (Immunosuppressants) interact with melatoninMelatonin might increase the immune system. Taking melatonin along with medications that decrease the immune system might decrease the effectiveness of medications that decrease the immune system.Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.
• Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs) interact with melatoninMelatonin might slow blood clotting. Taking melatonin along with medications that also slow clotting might increase the chances of bruising and bleeding.Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.
• Nifedipine GITS (Procardia XL) interact with melatonin
  Nifedipine GITS (Procardia XL) is used to lower blood pressure. Taking melatonin might decrease the effectiveness of nifedipine GITS for lowering blood pressure.
• Sedative medications (Benzodiazepines) interact with melatonin
  Melatonin might cause sleepiness and drowsiness. Drugs that cause sleepiness and drowsiness are called sedatives. Taking melatonin along with sedative medications might cause too much sleepiness.
  Some of these sedative medications include clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), and others.
• Verapamil (Calan, Covera, Isoptin, Verelan) interact with melatonin
  The body breaks down melatonin to get rid of it. Verapamil (Calan, Covera, Isoptin, Verelan) can increase how quickly the body gets rid of melatonin. Taking melatonin along with verapamil (Calan, Covera, Isoptin, Verelan) might decrease the effectiveness of melatonin.

Special Precautions & Warnings

Pregnancy and breast-feeding: Melatonin is POSSIBLY UNSAFE when taken by mouth or injected into the body during pregnancy. Do not use it. Melatonin might also interfere with ovulation, making it more difficult to become pregnant.

Not enough is known about the safety of using melatonin when breast-feeding. It is best not to use it.

Children: Melatonin is POSSIBLY SAFE when taken by mouth as a single dose. It is POSSIBLY UNSAFE when taken by mouth or injected into the body in multiple doses in the short-term. Because of its effects on other hormones, melatonin might interfere with development during adolescence.

Bleeding disorders: Melatonin might make bleeding worse in people with bleeding disorders.

Depression: Melatonin can make symptoms of depression worse.

Diabetes: Melatonin might increase blood sugar in people with diabetes. Monitor your blood sugar carefully, if you have diabetes and take melatonin.

High blood pressure: Melatonin can raise blood pressure in people who are taking certain medications to control blood pressure. Avoid using it.

Seizure disorders: Using melatonin might increase the risk of having a seizure.

Transplant recipients: Melatonin can increase immune function and might interfere with immunosuppressive therapy used by people receiving transplants.

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