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Encephale. 2018 Dec;44(6):548-557. doi: 10.1016/j.encep.2018.06.005. Epub 2018 Aug 11.

[Melatonin: Physiological and pharmacological aspects related to sleep: The interest of a prolonged-release formulation (Circadin®) in insomnia].

[Article in French]

Author information

1
Unité de sommeil, département de physiologie, hôpital Raymond-Poincaré, université Versailles Saint-Quentin-en-Yvelines, AP-HP, 92380 Garches, France.
2
Association nationale de promotion des connaissances du sommeil (Prosom), 292, rue Vendôme, 69003 Lyon, France. Electronic address: Bruno.claustrat@sfr.fr.

Abstract

Melatonin is a hormone secreted by the pineal gland. It displays a very marked nycthohemeral rhythm, which is entrained to the light dark cycle. The secretion spreads over 8-10 hours, with a maximum around 3-4 a.m. Melatonin plays the role of an endogenous synchronizer which regulates circadian rhythms, especially the sleep/wake and temperature rhythms. Acute melatonin administration reduces sleep latency, increases theta/alpha power and spindle activity (soporific activity). Fast-release melatonin preparations showed inconstant effects in insomnia. Melatonin displays a short blood half-life, a fast turn over and undergoes a high first-pass hepatic metabolism. More than 80% is excreted exclusively in the urine as 6-sulfatoxymelatonin. The individual's capacity to produce the endogenous hormone, the decline in circadian clock output and the increase in complaints of poor sleep quality at older age led to develop a prolonged-release melatonin preparation to mimic the endogenous secretion in patients. This reviews provides data on physiological and pharmacological melatonin effects related to sleep and summarizes trials published about Circadin® efficacy and tolerance in insomnia. Preliminary therapeutic data on other indications are given. The main clinically relevant benefits are improvements in sleep quality and latency, next-day morning alertness and quality of life. The response develops over several days. An oral 2-mg dose once daily, for 3 months, is generally well tolerated with no rebound, withdrawal or 'hangover' effects and no safety concerns on concomitant therapy with antihypertensive, antidiabetic, lipid-lowering or anti-inflammatory drugs. Untoward effects of hypnotics on cognition, memory, postural stability and sleep structure are not seen with Circadin®. Given as a first-line prescription, with 13 weeks' posology and the lack of rebound effects, Circadin® has the potential to improve quality of life in insomnia patients aged 55 years and older and avoid long-term use of hypnotics.

KEYWORDS:

Elderly; Hypnotics; Hypnotiques; Insomnia; Insomnie; Libération prolongée; Melatonin; Mélatonine; Prolonged-release; Vieillissement

PMID:
30107892
DOI:
10.1016/j.encep.2018.06.005
[Indexed for MEDLINE]

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