Efficacy and Safety of Preoperative Melatonin for Women Undergoing Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials
Melatonin has been cited in the literature for its use in various surgical procedures such as reducing pain following back surgery and reducing sepsis following surgery. The exploration of melatonin therapy for c-section pain is clinically relevant since over 32% of all women undergo cesarean section for childbirth. Due to melatonin’s safety profile, the use of melatonin pre-operatively to assist in pain management may be a plausible therapy for surgeons and clinicians to consider, with the greatest benefit resulting from a single dose of 10 mg of melatonin prior to surgery.
The Microbiota-Dependent Worsening Effects of Melatonin on Gut Inflammation.
At present, there is mixed evidence for the use of melatonin as a potential therapy for IBD with 50 publications in Pubmed using the search terms “inflammatory bowel disease” and “melatonin” (as of May 11, 2023). Of these publications, there is limited clinical data to suggest that melatonin supplementation may be therapeutic for those with IBD. This is an animal (mouse) study that needs to be viewed within the larger context of existing research, concepts, and application of melatonin in IBD, which encompasses both ulcerative colitis and Crohn’s disease.
Reply to Pluta, R. Comment on "Minich et al. Is Melatonin the "Next Vitamin D"?: A Review of Emerging Science, Clinical Uses, Safety, and Dietary Supplements.
“In conclusion, we are grateful to Dr. Pluta for raising the question about the similarities between vitamin D and melatonin and whether the two may be seen as having identical functions, particularly for brain and neurological health. To reiterate, while we would not want to suggest that the two are interchangeable, we documented that they could target common mechanistic pathways underlying the pathologies of several chronic diseases and even foster healthy brain aging.”
The efficacy of exogenous melatonin supplement in ameliorating irritable bowel syndrome severity: A meta-analysis of randomized controlled trials.
This article supports the emerging literature on melatonin’s mechanism of action through the GI tract, along with its antioxidant activities. Enterochromaffin cells in the gut contain approximately 400 times more melatonin than what is produced in the pineal gland. This release of melatonin in the gut increases gastric mucosa and gut motility and has been shown to have a protective effect on the GI tract via its antioxidant activities. The data from the 4 RCTs provide a foundation to consider melatonin as a therapy for patients with IBS. A clinician should carefully assess the individual and make recommendations according to their personalized needs. Three of the four studies included the dose of 3 mg melatonin at bedtime, which aligns with other studies reported in a review article.
The effect of treatment with melatonin on primary school aged children with difficulty in initiation and maintenance of sleep.
The use of melatonin in children for sleep concerns is a topic we have routinely examined, reported on, and reviewed as literature becomes available. We agree that other approaches, especially sleep hygiene, should be addressed first prior to melatonin therapy considering that endogenous production of melatonin is high in this age group. This short-term study does support existing literature that demonstrates the safety profile of melatonin in children, with a maximum dose of 3 mg for children and 5 mg for adolescents, in those who need it. The use of melatonin for children should always be discussed with the child’s physician before starting supplementation.
Melatonin for premenstrual syndrome: A potential remedy but not ready.
Based on the data presented in this article, combined with other articles our team has reviewed, we contend that the research on melatonin for PMS and PMDD is an emerging area to monitor. At present, clear clinical guidelines for the dose and timing of melatonin for this specific health concern have not yet been established, however, based on preliminary data, it appears promising and aligns with other research...
Coping with Oxidative Stress in Reproductive Pathophysiology and Assisted Reproduction: Melatonin as an Emerging Therapeutical Tool.
This narrative review has provided a comprehensive summary of the multitude of ways melatonin is beneficial for fertility, whether conceiving naturally or using assisted reproductive techniques, with key points that can be shared with patients in a clinical setting. Additionally, for women with endometriosis or PCOS, a dose of 3 mg melatonin per day has been demonstrated to improve multiple aspects of hormonal health that may improve fertility outcomes. In clinical practice, our team has used 5 mg of melatonin for PCOS.
Current Insights into the Risks of Using Melatonin as a Treatment for Sleep Disorders in Older Adults.
This narrative review summarized current evidence and reported that melatonin is a safe therapy for sleep disorders in older adults, with non-statistical significance in reported adverse effects, of which the most common are headaches, daytime fatigue, and dizziness. It is best used at the lowest therapeutic dose (<1 mg), administered 30-60 minutes before bed. Since older adults are more likely to have other health conditions and take one or more prescription medications, it is prudent for clinicians to check for possible drug interactions and monitor patients after starting melatonin therapy. Aspects of monitoring include but are not limited to, blood pressure, daytime fatigue, labs (i.e., prothrombin time for those on warfarin), and sleep quality.
Melatonin as a Potential Approach to Anxiety Treatment.
This article provides a comprehensive summary of the possible mechanisms for action, each of which could be explored in greater detail in future human studies. While specific dosing of melatonin is not described in this review article, the clinical usefulness of understanding the possible mechanisms of action allow clinicians to implement this knowledge to consider melatonin as an option for the management of anxiety disorders.
Role of Melatonin in the Management of Sleep and Circadian Disorders in the Context of Psychiatric Illness.
This review provides an overview of the use of melatonin for sleep disorders in psychiatric illnesses and it may provide guidance to clinicians on possible doses of melatonin for select conditions.
Melatonin as an Antioxidant Agent in Stroke: An Updated Review.
While this article provides a deeper explanation of the role of oxidative stress in the pathophysiology of stroke, we are focused on details reported on the potential use of melatonin for stroke. Our main takeaway from this article is that melatonin continues to be highlighted in the literature for its antioxidant properties. The findings in the animal studies and limited human clinical trials are promising, though, we agree with the authors, that more studies are needed to determine the proper clinical application of melatonin in stroke patients
A phase II, single-center, double-blind, randomized placebo-controlled trial to explore the efficacy and safety of intravenous melatonin in surgical patients with severe sepsis admitted to the intensive care unit
High-dose IV melatonin administration improved clinical outcomes of ICU patients with sepsis that required surgery. While further studies are needed for the delivery and dose of melatonin for this purpose, the antioxidant and anti-inflammatory properties of melatonin appear to show promise as a possible adjuvant therapy for those with sepsis. Though melatonin is not being suggested as a standalone therapy for sepsis, we would stress the importance of utilizing all needed medical therapies to manage sepsis and all other infections. Our key takeaway from this article is that this study provides additional insight into the variation of dosing and delivery forms of melatonin that can be utilized clinically.
The Effect of Preoperative Oral Melatonin on Postoperative Pain after Lumbar Disc Surgery: A Double-Blinded Randomized Clinical Trial
Using oral melatonin was shown to be significant in reducing post-operative pain following a lumbar laminectomy/discectomy compared to placebo. Interestingly, while each of the three melatonin-treated groups reported less pain than the placebo group, there was not a significant difference in the pain reported between the melatonin-treated groups. Thus, the biggest takeaway from this article is that the model of using the lowest, most effective dose of melatonin for this clinical purpose may be best.
Essential Hypertension and Oxidative Stress: Novel Future Perspectives
We understand that essential hypertension has a complex pathology with many factors that impact development including but not limited to genetics, diet, and stress, and are aware that one therapy option is not a likely solution to this disease that impacts billions of people worldwide. With arterial stiffness being an indicator of cardiovascular morbidity and mortality, any improvement can be of clinical value
Melatonin, tunneling nanotubes, mesenchymal cells, and tissue regeneration
This is an area of melatonin research we will be monitoring with excitement. As the incidences of chronic diseases continue to rise, the need to effectively manage the diseases and improve the quality of life for those living with the diseases is of great interest. While it is too soon to provide clinical application, melatonin may be a plausible adjuvant to MSC therapy due to its mitochondria-regulating properties
Melatonin as an Antimicrobial Adjuvant and Anti-Inflammatory for the Management of Recurrent Clostridioides difficile Infection.
Clostridioides difficile (C. difficile) pathogenesis has a strong association with inflammation. One function of melatonin is that it is a powerful anti-inflammatory and antioxidant, with existing research demonstrating the benefits for GI health, making it a reasonable choice as a potential therapy to aid in lowering inflammation.