Ramelta

Indications

Ramelteon is used to treat insomnia in adults when the main problem is difficulty falling asleep. It is not habit-forming and is not a controlled sedative.

How It Works

Ramelteon is a melatonin receptor agonist. Melatonin is a natural hormone that helps control the body's sleep and wake cycle. Ramelteon acts on the same receptors in the brain (MT1 and MT2), which helps signal to the body that it is time to sleep, shortening the time it takes to fall asleep.

Dosage and Administration

Adults: usually 8 mg taken within 30 minutes before going to bed, or as prescribed. Do not take more than 8 mg in one night. Do not take it with or just after a high-fat meal, as this delays its effect. Only take it when you can stay in bed for a full night's sleep. Tell your doctor if sleep problems continue after 7 to 10 days.

Interactions

• Fluvoxamine greatly increases Ramelteon levels: do not use them together.
• Ketoconazole, Fluconazole and Ciprofloxacin can raise its levels.
• Rifampicin can reduce its effect.
• Alcohol and other sleeping medicines increase drowsiness; avoid alcohol.

Contraindications

• Allergy to Ramelteon.
• Severe liver disease.
• Use together with Fluvoxamine.

Side Effects

Common effects include sleepiness the next day, dizziness, tiredness, nausea and headache. It may make insomnia or depression worse in some people. Rarely it affects hormones, causing missed periods, milky nipple discharge, reduced sex drive or fertility problems. Unusual behaviour during sleep, such as sleep-walking or sleep-driving, has been reported with sleep medicines.

Stop taking it and get urgent medical help if you have swelling of the tongue, face or throat, difficulty breathing, worsening depression or thoughts of self-harm, or complex sleep behaviours.

Pregnancy and Lactation

There is not enough information about use in pregnancy, so it should be avoided unless your doctor advises it. It is not known whether it passes into breast milk; it is usually avoided while breastfeeding.

Precautions and Warnings

• Do not drive or do anything needing alertness after taking it.
• Use with care in moderate liver disease, sleep apnoea and severe lung disease.
• Insomnia lasting more than 7 to 10 days may be a sign of another illness; see a doctor.

Overdose

Overdose may cause heavy sleepiness. Seek medical help.

Therapeutic Class

Hypnotic, melatonin receptor agonist.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.