Posted by Jost on September 24, 2006, at 12:42:48
In reply to Re: sleep - melatonin, temazepam, bipolar manageme, posted by survivin bpd on September 24, 2006, at 11:54:54
The melatonin study I had heard about was done at the U of Alberta.
This following seems to have the same general info, not sure of the relationship to the Alberta study.
http://www.ahrq.gov/clinic/epcsums/melatsum.htm
or in PDF
http://www.ahrq.gov/clinic/epcsums/melatsum.pdf#search=%22melatonin%20effectiveness%20studies%22Main point:
Overall, the one area where melatonin affected sleep onset was in those with the primary sleep disorder Delayed Sleep Phase Sydrome (DSPS) where people tend to stay up much later (ie the "nightowl" type of pattern).
For other disorders, particularly insomnia, it had no clinically significant effect.
On the other hand, given that you're using some powerful drugs that affect sleep, I'm not sure how melatonin would interact to affect sleep onset.
Btw, melatonin didn't improve sleep after onset- ie awakenings, etc-- which you seem to have experienced.
``
Ramelteon is marketed as Rozerem by Takeda Pharmaceuticals North America. I haven't heard much about it.One issue for you with Ramelteon, since you take carbamazepine:
"Another important metabolism consideration for the prescriber is to evaluate concurrent medications that may be inducers and inhibitors of the CYP 1A2 system. Because of ramelteon’s extensive metabolism by the CYP 1A2 enzyme system, providers must be cognizant of medications that may either induce or inhibit this system, therefore leading to an altered metabolism of ramelteon. Ramelteon does not appear to exert an inducing or inhibiting effect on the CYP 1A2 system; rather, other medications that affect this isoenzyme system can affect the levels of ramelteon. 4 For example, ramelteon should not be used in combination with fluvoxamine, ciprofloxacin, niacin, mexiletine, norfloxacin (Noroxin), tacrine (Cognex), and zileuton (Zyflo), as they are all CYP 1A2 inhibitors. Efficacy and availability of ramelteon may be reduced when given concurrently with CYP 1A2 inducers such as rifampin, barbiturates, carbamazepine, and smoking. When administered with rifampin, there was a mean decrease (80%) in blood levels of ramelteon. 4 Finally, providers should use caution in prescribing ramelteon to patients who are using kava kava, as this has been reported to inhibit many CYP isoenzymes and may increase levels of ramelteon."
Also noted in this paper was that median peak serum concentration is about 45 minutes after ingestion and half life is 1-2 hours. So it's important to take right before sleep.
If you're interested, here are some references from the article (which was on Medline, if you have access):
"Ramelteon (Rozerem) a Novel Approach for Insomnia Treatment
[Departments: Drug News]Laustsen, Gary PhD, APRN, BC, Drug News Editor; Andersen, Megan RN, MS, OCN..."
Their references were:
1. National Center on Sleep Disorders Research: U.S. Department of Health and Human Services. 2003 National Sleep Disorders Research Plan. Available at: http://www.nhlbi.nih.gov/health/prof/sleep/res_plan/sleep-rplan.pdf . Accessed February 2, 2006. [Context Link]
2. National Center on Sleep Disorders Research and Office of Prevention, Education and Control. Insomnia: Assessment and Management in Primary Care. Available at: http://www.nhlbi.nih.gov/health/prof/sleep/insom_pc.pdf.Accessed February 2,2006. [Context Link]
3. Takeda Pharmaceuticals.Rozerem [package insert]. Takeda Pharmaceuticals. Lincolnshire, IL; 2005. [Context Link]
4. Clinical Pharmacology – Customized Monograph. Rozerem: ramelteon. Available at: http://cpip.gsm.com . Accessed October 28, 2005. [Context Link]
5. Cada DJ, Levien T, Baker DE. Ramelteon. Hosp Pharm. 2006; 41(1):59–69. [Context Link]
6. Kato K, Hirai K, Nishiyama K, et al. Neurochemical properties of ramelteon (TAK-375), a selective MT1/MT2 receptor agonist. Neuropharmacology. 2005; 48(2): 301–310. Bibliographic Links [Context Link]
7. Roth T, Stubbs C, Walsh JK. Ramelteon (TAK-375), a selective MT1/MT2-receptor agonist, reduces latency to persistent sleep in a model of transient insomnia related to a novel sleep environment. Sleep. 2005;28(3): 303–307. Bibliographic Links [Context Link]"
I'm not sure about melatonin dose. Also, are you sure about the pharmaceutical purity of the melatonin you have? If from a health store, it could be of questionable contents. (Don't know how that works in UK, but in US, health food products don't have to meet governmental standards.)
Hope that helps a little.
Jost
poster:Jost
thread:688575
URL: http://www.dr-bob.org/babble/20060919/msgs/688683.html