August 30, 2015

Melatonin

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Are there any interactions with medications?



Birth control pills (Contraceptive drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Caffeine might increase or decrease melatonin levels in the body. When taken together with melatonin supplements, caffeine seems to increase melatonin levels.



Fluvoxamine (Luvox)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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 changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Melatonin might decrease how quickly the liver breaks down some medications. Taking melatonin along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking melatonin, talk to your healthcare provider if you are taking any medications that are changed by the liver.

Some medications changed by the liver include acetaminophen (Tylenol), amitriptyline (Elavil), clopidogrel (Plavix), clozapine (Clozaril), diazepam (Valium), estradiol, olanzapine (Zyprexa), ondansetron (Zofran), propranolol (Inderal), ropinirole (Requip), tacrine (Cognex), theophylline, verapamil (Calan, Covera-HS, Isoptin, Verelan), warfarin (Coumadin), and others.



Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Melatonin might decrease how quickly the liver breaks down some medications. Taking melatonin along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking melatonin, talk to your healthcare provider if you are taking any medications that are changed by the liver.

Some medications changed by the liver include amitriptyline (Elavil), carisoprodol (Soma), citalopram (Celexa), diazepam (Valium), lansoprazole (Prevacid), omeprazole (Prilosec), phenytoin (Dilantin), warfarin, and many others.



Medications for diabetes (Antidiabetes drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

There is some concern that melatonin might increase or decrease blood sugar. Diabetes medications are used to lower blood sugar. By affecting blood sugar, melatonin might decrease or increase 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 for high blood pressure (Antihypertensive drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Melatonin might decrease blood pressure in healthy people. However, melatonin might make blood pressure worse in people who are already taking medications for high blood pressure. Do not take too much melatonin if you are taking medications for high blood pressure.

Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), Amlodipine (Norvasc), hydrochlorothiazide (HydroDiuril), furosemide (Lasix), and many others.



Medications that decrease the immune system (Immunosuppressants)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Melatonin 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 lower the seizure threshold
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Melatonin might increase the frequency of seizures in some people, particularly children. Taking melatonin with drugs that lower the seizure threshold might increase the risk of a seizure.

Some medications that lower seizure threshold include anesthetics (propofol, others), antiarrhythmics (mexiletine), antibiotics (amphotericin, penicillin, cephalosporins, imipenem), antidepressants (bupropion, others), antihistamines (cyproheptadine, others), immunosuppressants (cyclosporine), narcotics (fentanyl, others), stimulants (methylphenidate), theophylline, and others.



Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Melatonin 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.



Medications used to prevent seizures (Anticonvulsants)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Melatonin might increase the frequency of seizures in some people, particularly children with multiple neurological disorders. In theory, taking melatonin might decrease the effectiveness of medications used to prevent seizures.

Some medications used to prevent seizures include phenobarbital, primidone (Mysoline), valproic acid (Depakene), gabapentin (Neurontin), carbamazepine (Tegretol), phenytoin (Dilantin), and others.



Methamphetamine
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Taking melatonin with methamphetamine might increase the effects and side effects of methamphetamine.



Nifedipine GITS (Procardia XL)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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.



Sedative medications (CNS depressants)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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.



Verapamil (Calan, Covera, Isoptin, Verelan)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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.



Flumazenil (Romazicon)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Flumazenil (Romazicon) might decrease the effects of melatonin. It is not yet clear why this interaction occurs. Taking flumazenil (Romazicon) along with melatonin might decrease the effectiveness of melatonin supplements.

Dosing considerations for Melatonin.

The following doses have been studied in scientific research:

BY MOUTH:
  • For insomnia:
    • 0.3-5 mg at bedtime is a typical dose.
    • In children with insomnia due to delayed sleep onset, melatonin 5 mg at 6:00 PM daily.
    • In children with developmental disorders (including cerebral palsy, autism, and intellectual disabilities), melatonin 5 mg at 8:00 PM daily. Both immediate-release and sustained-release preparations have been used.
  • For jet lag: 0.5-5 mg at bedtime is commonly taken on the arrival day at the destination, continuing for 2-5 days. Low doses of 0.5-3 mg are often used to avoid the hypnotic properties of the higher 4-5 mg doses.
  • For tardive dyskinesia (TD): 10 mg daily of a controlled-release formulation.
  • As treatment for solid tumors in combination with conventional therapy: 10-50 mg along with radiotherapy, chemotherapy, or interleukin 2 (IL-2). Melatonin is typically started 7 days before the start of chemotherapy and continued throughout full treatment course.
  • For treatment of prostate cancer that has spread to other sites (metastatic cancer) and is resistant to triptorelin used alone: 20 mg taken daily has been used in combination with 3.75 mg of triptorelin injected into the muscle every 28 days.
  • For prevention and treatment of lowered clot-forming cells (thrombocytopenia) associated with cancer chemotherapy: 20 mg each evening.
  • For benzodiazepine withdrawal in elderly people with insomnia: 2 mg of controlled-release melatonin taken at bedtime for 6 weeks (the benzodiazepine dosage is reduced 50% during the second week, 75% during weeks 3 and 4, and stopped during weeks 5 and 6) and continued up to 6 months.
  • For prevention of cluster headache: an evening dose of 10 mg.
  • For reducing anxiety before surgery in adults: 0.05 mg/kg under the tongue.
  • For reducing nicotine withdrawal symptoms: 0.3 mg orally 3.5 hours after stopping smoking.

Therapeutic Research Faculty copyright

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