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Tuft C, Matar E, Menczel Schrire Z, Grunstein RR, Yee BJ, Hoyos CM. Current Insights into the Risks of Using Melatonin as a Treatment for Sleep Disorders in Older Adults. Clin Interv Aging 2023; 18:49-59. [PMID: 36660543 PMCID: PMC9842516 DOI: 10.2147/cia.s361519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Exogenous melatonin is commonly used for sleep disorders in older adults, and its use is increasing over time. It appears to have modest efficacy in treating insomnia and circadian rhythm sleep-wake disorders. Melatonin is commonly perceived to be a safe alternative to other hypnotics and is available without prescription in some jurisdictions. New evidence suggests that endogenous melatonin has pleomorphic effects on multiple organ systems, many of which are poorly understood. This narrative review summarizes the current evidence regarding the safety of melatonin in older adults (defined by age over 65 years). Melatonin appears to have a favorable safety profile in this population, however there is a dearth of evidence regarding the safety of prolonged use. There are several factors which increase the risk of adverse effects of melatonin in older adults, and these should be taken into consideration when prescribing to this population.
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Affiliation(s)
- Colin Tuft
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Elie Matar
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia
| | - Zoe Menczel Schrire
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Brendon J Yee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia,Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia,School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia,Correspondence: Camilla M Hoyos, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney Medical School, Sydney, NSW, Australia, Tel +61 2 9114 0409, Email
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Is Melatonin the “Next Vitamin D”?: A Review of Emerging Science, Clinical Uses, Safety, and Dietary Supplements. Nutrients 2022; 14:nu14193934. [PMID: 36235587 PMCID: PMC9571539 DOI: 10.3390/nu14193934] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Melatonin has become a popular dietary supplement, most known as a chronobiotic, and for establishing healthy sleep. Research over the last decade into cancer, Alzheimer’s disease, multiple sclerosis, fertility, PCOS, and many other conditions, combined with the COVID-19 pandemic, has led to greater awareness of melatonin because of its ability to act as a potent antioxidant, immune-active agent, and mitochondrial regulator. There are distinct similarities between melatonin and vitamin D in the depth and breadth of their impact on health. Both act as hormones, affect multiple systems through their immune-modulating, anti-inflammatory functions, are found in the skin, and are responsive to sunlight and darkness. In fact, there may be similarities between the widespread concern about vitamin D deficiency as a “sunlight deficiency” and reduced melatonin secretion as a result of “darkness deficiency” from overexposure to artificial blue light. The trend toward greater use of melatonin supplements has resulted in concern about its safety, especially higher doses, long-term use, and application in certain populations (e.g., children). This review aims to evaluate the recent data on melatonin’s mechanisms, its clinical uses beyond sleep, safety concerns, and a thorough summary of therapeutic considerations concerning dietary supplementation, including the different formats available (animal, synthetic, and phytomelatonin), dosing, timing, contraindications, and nutrient combinations.
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Abstract
Melatonin is a hormonal product of the pineal gland, a fact that is often forgotten. Instead it is promoted as a dietary supplement that will overcome insomnia, as an antioxidant and as a prescription only drug in most countries outside the United States of America and Canada. The aim of this review is to step back and highlight what we know about melatonin following its discovery 60 years ago. What is the role of endogenous melatonin; what does melatonin do to sleep, body temperature, circadian rhythms, the cardiovascular system, reproductive system, endocrine system and metabolism when administered to healthy subjects? When used as a drug/dietary supplement, what safety studies have been conducted? Can we really say melatonin is safe when it has not been systematically studied and many studies show interactions with a wide range of physiological processes? Finally the results of studies investigating the efficacy of melatonin as a drug to alleviate insomnia are critically evaluated. In summary, melatonin is an endogenous pineal gland hormone with specific physiological functions in animals and humans, with its primary role in humans to maintain synchrony of sleep with the day/night cycle. When administered as a drug it affects a wide range of physiological systems and has clinically important drug interactions. With respect to efficacy for treating sleep disorders, melatonin can advance the time of sleep onset but the effect is modest and variable. In children with neurodevelopmental disabilities melatonin appears to have the greatest impact on sleep onset but little effect on sleep efficiency.
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Affiliation(s)
- David J Kennaway
- Robinson Research Institute and Adelaide School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Silva-Adaya D, Garza-Lombó C, Gonsebatt ME. Xenobiotic transport and metabolism in the human brain. Neurotoxicology 2021; 86:125-138. [PMID: 34371026 DOI: 10.1016/j.neuro.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023]
Abstract
Organisms have metabolic pathways responsible for eliminating endogenous and exogenous toxicants. Generally, we associate the liver par excellence as the organ in charge of detoxifying the body; however, this process occurs in all tissues, including the brain. Due to the presence of the blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB), the Central Nervous System (CNS) is considered a partially isolated organ, but similar to other organs, the CNS possess xenobiotic transporters and metabolic pathways associated with the elimination of xenobiotic agents. In this review, we describe the different systems related to the detoxification of xenobiotics in the CNS, providing examples in which their association with neurodegenerative processes is suspected. The CNS detoxifying systems include carrier-mediated, active efflux and receptor-mediated transport, and detoxifying systems that include phase I and phase II enzymes, as well as those enzymes in charge of neutralizing compounds such as electrophilic agents, reactive oxygen species (ROS), and free radicals, which are products of the bioactivation of xenobiotics. Moreover, we discuss the differential expression of these systems in different regions of the CNS, showing the different detoxifying needs and the composition of each region in terms of the cell type, neurotransmitter content, and the accumulation of xenobiotics and/or reactive compounds.
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Affiliation(s)
- Daniela Silva-Adaya
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico; Laboratorio Experimental de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía, Mexico, 14269, Mexico
| | - Carla Garza-Lombó
- Department of Pharmacology and Toxicology, The Stark Neurosciences Research Institute, Indiana University School of Medicine, 320 West 15th Street, NB, Indianapolis, IN, 46202, USA
| | - María E Gonsebatt
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico.
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Jiang W, Tian X, Wang Y, Sun Z, Dong P, Wang C, Huo X, Zhang B, Huang S, Deng S, Wang X, Ma X. The natural anthraquinones from Rheum palmatum induced the metabolic disorder of melatonin by inhibiting human CYP and SULT enzymes. Toxicol Lett 2016; 262:27-38. [DOI: 10.1016/j.toxlet.2016.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/02/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
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Spruyt K, Braam W, Smits M, Curfs LM. Sleep Complaints and the 24-h Melatonin Level in Individuals with Smith-Magenis Syndrome: Assessment for Effective Intervention. CNS Neurosci Ther 2016; 22:928-935. [PMID: 27743421 DOI: 10.1111/cns.12653] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022] Open
Abstract
AIMS Individuals with Smith-Magenis syndrome (SMS) are reported to have a disrupted circadian rhythm. Our aim was to examine problematic sleeping in those attending our sleep clinic for the first time. METHODS At intake, caregivers of 50 children and nine adults with SMS were surveyed about the sleep pattern and potential melatonin administration. Sampling of salivary melatonin levels was performed. RESULTS At intake, exogenous melatonin was used by 16 children (27.1% of sample; 56.3% male) with mean age 6.8 ± 2.8 years, whereas 34 children (57.6%; 7.5 ± 4.8 years old; 64.7% male) and nine adults (15.3%; 36.8 ± 15.3 years old; 44.4% male) were not taking melatonin at intake. Participants were reported to have problems with night waking and early awakenings regardless of melatonin administration. Overall, moderate to high levels of salivary melatonin at noon were found in individuals with SMS. In particular, children with SMS showed a disrupted melatonin pattern. Furthermore, the endogenous melatonin level, age, and gender may potentially interact, yielding the severity range of sleep disturbances reported in SMS. CONCLUSION Treatment of sleep problems in SMS is complex, and our findings may support person-centered sleep and medication management. Future clinical trials including larger groups may shed light on such approaches.
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Affiliation(s)
- Karen Spruyt
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands. .,Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Wiebe Braam
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands.,'s Heeren Loo Zuid-Veluwe, Wekerom, Netherlands
| | - Marcel Smits
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands.,Department of Neurology, Gelderse Vallei Hospital, Ede, Netherlands
| | - Leopold Mg Curfs
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands.,Department of Genetics, Maastricht University Medical Centre, Maastricht, Netherlands
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Wang C, Huo X, Tian X, Xu M, Dong P, Luan Z, Wang X, Zhang B, Zhang B, Huang S, Deng S, Ma X. Inhibition of melatonin metabolism in humans induced by chemical components from herbs and effective prediction of this risk using a computational model. Br J Pharmacol 2016; 173:3261-3275. [PMID: 27588415 DOI: 10.1111/bph.13612] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/08/2016] [Accepted: 08/24/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Herbs which are widely used as food and medicine, are involved in many physiopathological processes. Melatonin is a human hormone, synthesized and secreted by the pineal gland, with a range of biological functions. Here, we have evaluated the potential influences of components extracted from common herbs on melatonin metabolism in humans. EXPERIMENTAL APPROACH An in vivo pharmacokinetic study involving 12 healthy subjects, in vitro incubations with human liver microsomes (HLMs) and recombinant human cytochrome P (CYP) isoenzymes and an in silico quantitative structure-activity relationship (QSAR) model analysis using comparative molecular field analysis and comparative molecular similarity indices analysis methods were employed to explore these interactions. KEY RESULTS After systematic screening of 66 common herbs, Angelica dahurica exhibited the most potent inhibition of melatonin metabolism in vitro. The in vivo pharmacokinetic study indicated inhibition of melatonin metabolism, with approximately 12- and 4-fold increases in the AUC and Cmax of melatonin in human subjects. Coumarins from A. dahurica, including imperatorin, isoimperatorin, phellopterin, 5-methoxypsoralen and 8-methoxypsoralen, markedly inhibited melatonin metabolism with Ki values of 14.5 nM, 38.8 nM, 6.34 nM, 5.34 nM and 18 nM respectively, through inhibition of CYP 1A2, 1A1 and 1B1 in HLMs. A QSAR model was established and satisfactorily predicted the potential risk of coumarins for inhibition of melatonin metabolism in vivo. CONCLUSION AND IMPLICATIONS Coumarins from A. dahurica inhibited melatonin metabolism in vivo and in vitro. Our findings provide vital guidance for the clinical use of melatonin.
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Affiliation(s)
- Chao Wang
- Academy of Integrative Medicine, College of Pharmacy, Key Laboratory of Pharmacokinetic and Drug Transport of Liaoning, Dalian Medical University, Dalian, China.,Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaokui Huo
- Academy of Integrative Medicine, College of Pharmacy, Key Laboratory of Pharmacokinetic and Drug Transport of Liaoning, Dalian Medical University, Dalian, China
| | - Xiangge Tian
- Academy of Integrative Medicine, College of Pharmacy, Key Laboratory of Pharmacokinetic and Drug Transport of Liaoning, Dalian Medical University, Dalian, China
| | - Min Xu
- Academy of Integrative Medicine, College of Pharmacy, Key Laboratory of Pharmacokinetic and Drug Transport of Liaoning, Dalian Medical University, Dalian, China
| | - Peipei Dong
- Academy of Integrative Medicine, College of Pharmacy, Key Laboratory of Pharmacokinetic and Drug Transport of Liaoning, Dalian Medical University, Dalian, China
| | - Zhilin Luan
- Academy of Integrative Medicine, College of Pharmacy, Key Laboratory of Pharmacokinetic and Drug Transport of Liaoning, Dalian Medical University, Dalian, China
| | - Xiaobo Wang
- Department of Pharmacy and Traditional Chinese Medicine, Chinese People's Liberation Army 210 Hospital, Dalian, China
| | - Baojing Zhang
- Academy of Integrative Medicine, College of Pharmacy, Key Laboratory of Pharmacokinetic and Drug Transport of Liaoning, Dalian Medical University, Dalian, China
| | - Bo Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Shanshan Huang
- Academy of Integrative Medicine, College of Pharmacy, Key Laboratory of Pharmacokinetic and Drug Transport of Liaoning, Dalian Medical University, Dalian, China
| | - Sa Deng
- Academy of Integrative Medicine, College of Pharmacy, Key Laboratory of Pharmacokinetic and Drug Transport of Liaoning, Dalian Medical University, Dalian, China
| | - Xiaochi Ma
- Academy of Integrative Medicine, College of Pharmacy, Key Laboratory of Pharmacokinetic and Drug Transport of Liaoning, Dalian Medical University, Dalian, China. .,Department of Neurosurgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
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Kennaway DJ. Potential safety issues in the use of the hormone melatonin in paediatrics. J Paediatr Child Health 2015; 51:584-9. [PMID: 25643981 DOI: 10.1111/jpc.12840] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 11/29/2022]
Abstract
Melatonin is a hormone produced by the pineal gland during the night in response to light/dark information received by the retina and its integration by the suprachiasmatic nucleus. When administered to selected populations of adults, in particular those displaying delayed sleep phase disorder, melatonin may advance the time of sleep onset. It is, however, being increasingly prescribed for children with sleep disorders despite the fact that (i) it is not registered for use in children anywhere in the world; (ii) it has not undergone the formal safety testing expected for a new drug, especially long-term safety in children; (iii) it is known to have profound effects on the reproductive systems of rodents, sheep and primates, as well as effects on the cardiovascular, immune and metabolic systems; and (iv) there is the potential for important interactions with drugs sometimes prescribed for children. In this review, I discuss properties of melatonin outside its ability to alter sleep timing that have been widely ignored but which raise questions about the safety of its use in infants and adolescents.
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Affiliation(s)
- David J Kennaway
- Robinson Research Institute, Medical School, University of Adelaide, Adelaide, South Australia, Australia.,School of Paediatrics and Reproductive Health, Medical School, University of Adelaide, Adelaide, South Australia, Australia
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Papagiannidou E, Skene DJ, Ioannides C. Potential drug interactions with melatonin. Physiol Behav 2014; 131:17-24. [PMID: 24732412 DOI: 10.1016/j.physbeh.2014.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 01/24/2023]
Abstract
Possible interactions of melatonin with concurrently administered drugs were investigated in in vitro studies utilising human hepatic post-mitochondrial preparations; similar studies were conducted with rat preparations to ascertain whether rat is a suitable surrogate for human. Drugs were selected based not only on the knowledge that the 6-hydroxylation of exogenous melatonin, its principal pathway of metabolism, is mainly mediated by hepatic CYP1A2, but also on the likelihood of the drug being concurrently administered with melatonin. Hepatic preparations were incubated with either melatonin or 6-hydroxymelatonin in the presence and absence of a range of concentrations of interacting drug, and the production of 6-sulphatoxymelatonin monitored using a radioimmunoassay procedure. Of the drugs screened, only the potent CYP1A2 inhibitor 5-methoxypsoralen impaired the 6-melatonin hydroxylation at pharmacologically relevant concentrations, and is likely to lead to clinical interactions; diazepam, tamoxifen and acetaminophen (paracetamol) did not impair the metabolic conversion of melatonin to 6-sulphatoxymelatonin at concentrations attained following therapeutic administration. 17-Ethinhyloestradiol appeared not to suppress the 6-hydroxylation of melatonin but inhibited the sulphation of 6-hydroxymelatonin, but this is unlikely to result in an interaction following therapeutic intake of the steroid. Species differences in the inhibition of melatonin metabolism in human and rat hepatic post-mitochondrial preparations were evident implying that the rat may not be an appropriate surrogate of human in such studies.
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Affiliation(s)
- Eleni Papagiannidou
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Debra J Skene
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK.
| | - Costas Ioannides
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
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Al-Omary FAM. Melatonin: comprehensive profile. PROFILES OF DRUG SUBSTANCES, EXCIPIENTS, AND RELATED METHODOLOGY 2013; 38:159-226. [PMID: 23668405 DOI: 10.1016/b978-0-12-407691-4.00005-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This chapter includes the aspects of melatonin. The drug is synthesized in the pineal gland starting from tryptophane or synthetically by using indole as starting material. Melatonin has been used as an adjunct to interleukin-2 therapy for malignant neoplasms, as contraceptive, in the management of various forms of insomnia, to alleviate jet lag following long flights, and finally as free radical scavenger and hence as an antioxidant and an anti-inflammatory. The chapter discusses the drug metabolism and pharmacokinetics and presents various method of analysis of this drug such as biological analysis, spectroscopic analysis, and chromatographic techniques of separation. It also discusses its physical properties such as solubility characteristics, X-ray powder diffraction pattern, and thermal methods of analysis. The chapter is concluded with a discussion on its biological properties such as activity, toxicity, and safety.
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Affiliation(s)
- Fatmah A M Al-Omary
- Department of Pharmaceutical Chemistry, King Saud University, Riyadh, Kingdom of Saudi Arabia.
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MacDonald L, Murty M, Foster BC. Antiviral drug disposition and natural health products: risk of therapeutic alteration and resistance. Expert Opin Drug Metab Toxicol 2009; 5:563-78. [PMID: 19442034 DOI: 10.1517/17425250902942302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The HIV/AIDS patient population is known to use natural health products (NHPs) in addition to the several antiretroviral drugs that constitute the treatment regimen for this disease. This review focuses on NHPs and their potential for interactions with antiretroviral agents resulting in therapeutic alterations or resistance. There are conflicting published medical literature reports and very few well-documented human clinical studies that unequivocally demonstrate if this concomitant use increases the risk of interaction/adverse reaction with these therapeutic products. This article outlines some findings from the Canadian domestic adverse reaction case reports associated with the use of antiretrovirals and NHPs. These adverse reaction case reports were specifically examined for patients taking NHPs together with their highly active antiretroviral therapy during or around the time when the adverse reaction developed. Together, the case reports and limited human clinical studies suggest that the risk for therapeutic alterations and resistance can exist due to changes in pharmacokinetic parameters with concomitant use of these therapeutic products.
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Affiliation(s)
- Laura MacDonald
- Therapeutic Products Directorate Health Canada, Holland Cross, Tower B, Ottawa, Ontario, Canada
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Diurnal variation of melatonin and cortisol is maintained in non-septic intensive care patients. Intensive Care Med 2009; 35:1720-7. [DOI: 10.1007/s00134-009-1565-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 06/15/2009] [Indexed: 11/27/2022]
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