Not to be confused with Melanin or Melanotan.

| This article relies on references to primary sources. Please add references to secondary or tertiary sources. (March 2012)

API
Systematic (IUPAC) name
N-[2-(5-methoxy-1H-indol-3-yl)ethyl] acetamide
Clinical data
AHFS/Drugs.com | Consumer Drug Information
Pregnancy cat. | ?
Legal status | Prescription Only (S4) (AU) OTC (US)
Routes | In humans: orally, as capsules, tablets or liquid, sublingually, or as transdermal patches. In lab animals: also injection.
Pharmacokinetic data
Bioavailability | 30 ? 50%
Metabolism | Hepatic via CYP1A2 mediated 6-hydroxylation
Half-life | 35 to 50 minutes
Excretion | Urine
Identifiers
CAS number | 73-31-4 Y
ATC code | N05 CH01
PubChem | CID 896
IUPHAR ligand | 224
DrugBank | DB01065
ChemSpider | 872 Y
UNII | JL5DK93RCL Y
KEGG | D08170 Y
ChEBI | CHEBI:16796 N
ChEMBL | CHEMBL45 Y
Chemical data
Formula | C13H16N2O2
Mol. mass | 232.278 g/mol
SMILES CC(=O)NCCc1c[nH]c2c1cc(cc2)OC
InChI InChI=1S/C13H16N2O2/c1-9(16)14-6-5-10-8-15-13-4-3-11(17-2)7-12(10)13/h3-4,7-8,15H,5-6H2,1-2H3,(H,14,16) Y Key:DRLFMBDRBRZALE-UHFFFAOYSA-N Y
N (what is this?) (verify)

Melatonin i/ʔ m ʔ l ʔ ʔ t[unsupported input]n ʔ n/, also known chemically as N-acetyl-5-methoxytryptamine,[1] is a naturally occurring compound found in animals, plants, and microbes.[2][3] In animals, circulating levels of the hormone melatonin vary in a daily cycle, thereby allowing the entrainment of the circadian rhythms of several biological functions.[4]

Many biological effects of melatonin are produced through activation of melatonin receptors,[5] while others are due to its role as a pervasive and powerful antioxidant,[6] with a particular role in the protection of nuclear and mitochondrial DNA.[7]

Products containing melatonin have been available over-the-counter in the United States since the mid-1990s.[8] In many other countries, the sale of this neurohormone is not permitted or requires a prescription.

## Plants[edit]

Melatonin has been identified in many plants including Feverfew (Tanacetum parthenium), and St John's wort (Hypericum perforatum).[3] The physiological roles of melatonin in plants involve regulation of their response to photoperiod, defense against harsh environments, and the function of an antioxidant. The latter may be the original function of melatonin in organisms with the others being added during evolution.[9] Melatonin also regulates plant growth by its ability to slow root formation, while promoting above ground growth.[10]

Melatonin has been reported in foodstuffs including cherries to about 0.17-13.46?ng/g,[11] bananas and grapes, rice and cereals, herbs, olive oil, wine[12] and beer.

When bird chicks ingest melatonin-rich plant feed, such as rice, the melatonin binds to melatonin receptors in their brains.[13] No food has been found to elevate plasma melatonin levels in humans.[14]

## Animals[edit]

Many animals use the variation in duration of melatonin production each day as a seasonal clock.[15] In animals including humans[16] the profile of melatonin synthesis and secretion is affected by the variable duration of night in summer as compared to winter. The change in duration of secretion thus serves as a biological signal for the organisation of daylength-dependent (photoperiodic) seasonal functions such as reproduction, behaviour, coat growth and camouflage colouring in seasonal animals.[16] In seasonal breeders that do not have long gestation periods and that mate during longer daylight hours, the melatonin signal controls the seasonal variation in their sexual physiology, and similar physiological effects can be induced by exogenous melatonin in animals including mynah birds[17] and hamsters.[18]

In mammals, melatonin is biosynthesized in four enzymatic steps from the essential dietary amino acid tryptophan, with serotonin produced at the second step. Melatonin is secreted into the blood by the pineal gland in the brain. Known as the "hormone of darkness," it is secreted in darkness in both day-active (diurnal) and night-active (nocturnal) animals.[19] It may also be produced by a variety of peripheral cells such as bone marrow cells,[20][21] lymphocytes, and epithelial cells. Usually, the melatonin concentration in these cells is much higher than that found in the blood, but it does not seem to be regulated by the photoperiod.

## Mammals[edit]

Melatonin, produced in the pineal gland which is outside of the blood?brain barrier, acts as an endocrine hormone since it is released into the blood.[22]

Melatonin can suppress libido by inhibiting secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the anterior pituitary gland, especially in mammals that have a breeding season when daylight hours are long. The reproduction of long-day breeders is repressed by melatonin and the reproduction of short-day breeders is stimulated by melatonin. During the night, melatonin regulates leptin, lowering its levels.

Light/dark information reaches the suprachiasmatic nuclei (SCN) from retinal photosensitive ganglion cells, which are intrinsically photosensitive photoreceptor cells that are distinct from those involved in the primary (at least, from one point of view) image formation function of the eye (that is the rods and coness of the retina). These cells represent approximately 2% of all retinal ganglion cells in humans and express the photopigment melanopsin.[23]

Melanopsin, often confused with melatonin because of its similar name, is structurally unrelated to the hormone. It is a conventional 7-transmembrane opsin protein with the usual vitamin A-like cis-retinal cofactor having a peak absorption at 484?nm, in the blue light part of the visible spectrum.[24] The photoperiod cue created by blue light (from a blue image of the sky) entrains a circadian rhythm, and thus governs resultant production of specific "dark"- and "light"-induced neural and endocrine signals that regulate behavioral and physiological circadian rhythms associated with melatonin. Melatonin is secreted in darkness in both day-active (diurnal) and night-active (nocturnal) animals.[19]

## Humans[edit]

### Circadian rhythm[edit]

In humans, melatonin is produced by the pineal gland, a small endocrine gland[25] located in the center of the brain but outside the blood?brain barrier. The melatonin signal forms part of the system that regulates the sleep-wake cycle by chemically causing drowsiness and lowering the body temperature, but it is the central nervous system (specifically the suprachiasmatic nuclei, or SCN)[25] that controls the daily cycle in most components of the paracrine and endocrine systems[26][27] rather than the melatonin signal (as was once postulated).

Infants' melatonin levels become regular in about the third month after birth, with the highest levels measured between midnight and 08:00 (8 AM).[28]

In humans, 90% of melatonin is cleared in a single passage through the liver, a small amount is excreted in urine,[29] and a small amount is found in saliva.

Human melatonin production decreases as a person ages.[30] It is believed that as children become teenagers, the nightly schedule of melatonin release is delayed, leading to later sleeping and waking times.[31]

#### Light dependence[edit]

Production of melatonin by the pineal gland is inhibited by light to the retina and permitted by darkness. Its onset each evening is called the dim-light melatonin onset (DLMO).

It is principally blue light, around 460 to 480?nm, that suppresses melatonin,[32] proportional to the light intensity and length of exposure. Until recent history, humans in temperate climates were exposed to few hours of (blue) daylight in the winter; their fires gave predominantly yellow light. Wearing glasses that block blue light in the hours before bedtime may avoid melatonin loss. Kayumov et al. showed that light containing only wavelengths greater than 530?nm does not suppress melatonin in bright-light conditions.[33] Use of blue-blocking goggles the last hours before bedtime has also been advised for people who need to adjust to an earlier bedtime, as melatonin promotes sleepiness.[34]

When used several hours before sleep according to the phase response curve for melatonin in humans, small amounts of melatonin shift the circadian clock earlier, thus promoting earlier sleep onset and morning awakening.[35]

### Antioxidant[edit]

Besides its function as synchronizer of the biological clock, melatonin also exerts a powerful antioxidant activity. In many less complex life forms, this is its only known function.[36] Melatonin is an antioxidant that can easily cross cell membranes[37] and the blood?brain barrier.[6][38] This antioxidant is a direct scavenger of radical oxygen and nitrogen species including: OH, O2?, and NO.[10][39] Melatonin works with other antioxidants to improve the overall effectiveness from each antioxidant.[10] Unlike other antioxidants, melatonin does not undergo redox cycling, the ability of a molecule to undergo reduction and oxidation repeatedly. Redox cycling may allow other antioxidants (such as vitamin C) to act as pro-oxidants, counterintuitively promoting free radical formation. Melatonin, on the other hand, once oxidized, cannot be reduced to its former state because it forms several stable end-products upon reacting with free radicals. Therefore, it has been referred to as a terminal (or suicidal) antioxidant.[37]:p.189[40]

Recent research indicates that the first metabolite of melatonin in the melatonin antioxidant pathway may be N(1)-acetyl-N(2)-formyl-5-methoxykynuramine (or AFMK) rather than the common, excreted 6-hydroxymelatonin sulfate. AFMK alone is detectable in unicellular organisms and metazoans. A single AFMK molecule can neutralize up to 10 ROS/RNS (reactive oxygen species/reactive nitrogen species) since many of the products of the reaction/derivatives (including melatonin) are themselves antioxidants. This capacity to absorb free radicals extends at least to the quaternary metabolites of melatonin, a process referred to as "the free radical scavenging cascade." This is not true of other, conventional antioxidants.[36]

In animal models, melatonin has been demonstrated to prevent the damage to DNA by some carcinogens, stopping the mechanism by which they cause cancer.[41]

It also has been found to be effective in protecting against brain injury caused by ROS release in experimental hypoxic brain damage in newborn rats.[42] Melatonin's antioxidant activity may reduce damage caused by some types of Parkinson's disease, play a role in preventing cardiac arrhythmia and possibly increase longevity; it has been shown to increase the average life span of mice by 20% in some studies.[43][44][45]

### Immune system[edit]

While it is known that melatonin interacts with the immune system,[46][47] the details of those interactions are unclear. There have been few trials designed to judge the effectiveness of melatonin in disease treatment. Most existing data are based on small, incomplete clinical trials. Any positive immunological effect is thought to be the result of melatonin acting on high affinity receptors (MT1 and MT2) expressed in immunocompetent cells. In preclinical studies, melatonin may enhance cytokine production,[48] and by doing this counteract acquired immunodeficiences. Some studies also suggest that melatonin might be useful fighting infectious disease[20] including viral, such as HIV, and bacterial infections, and potentially in the treatment of cancer.[49]

Endogenous melatonin in human lymphocytes has been related to interleukin-2 (IL-2) production and to the expression of IL-2 receptor.[50] This suggests that melatonin is involved in the clonal expansion of antigen-stimulated human T lymphocytes. In rheumatoid arthritis patients, melatonin production has been found increased when compared to age-matched healthy controls.[51]

Although it has not yet been clearly demonstrated whether melatonin increases non-specific immunity with resulting contraindication in autoimmune diseases, an increase in the production of IL-2 and IL-1 was noted in cultured splenocytes.[52]

### Dreaming[edit]

Some supplemental melatonin users report an increase in vivid dreaming. Extremely high doses of melatonin (50?mg) dramatically increased REM sleep time and dream activity in people both with and without narcolepsy.[53] Many psychoactive drugs, such as cannabis and lysergic acid diethylamide (LSD), increase melatonin synthesis.[53] It has been suggested that nonpolar (lipid-soluble) indolic hallucinogenic drugs emulate melatonin activity in the awakened state and that both act on the same areas of the brain.[53]

### Autism[edit]

Individuals with autism spectrum disorders (ASD) may have lower than normal levels of melatonin. A 2008 study found that unaffected parents of individuals with ASD also have lower melatonin levels, and that the deficits were associated with low activity of the ASMT gene, which encodes the last enzyme of melatonin synthesis.[54]

Multiple small studies have demonstrated that 2 to 10?mg of melatonin may benefit children with ASD who have trouble falling asleep and/or maintaining sleep. A small 2011 randomized crossover trial found that the administration of melatonin, when compared to placebo, decreased sleep latency and increased total sleep time, but had no effect on the number of night time awakenings.[55] At this time, no guidelines exist for the use of melatonin in children with ASD.

### Aging[edit]

Research has supported the anti-aging properties of melatonin. Younger children hit their peak melatonin production at night, and some researchers believe that the level of melatonin peaks earlier as people get older. This may explain why older adults go to bed earlier, wake up earlier, and have more sleep problems than children do.[56]

Some studies have shown that melatonin plays a crucial part in the aging process and that it may act as an anti-aging agent when administered to older mice. It has been reported in one study that administration of melatonin in elderly mice may reverse this change in expression of some 13 genes, thus making them similar to those of younger mice.[57] Consuming melatonin may neutralize oxidative damage and delay the neurodegenerative process of aging.[37] When small amounts of melatonin were administered to lab mice, it reduced the oxidative damage caused by aging and delayed the inflammatory process, which in turn increased the longevity of the mice.[58]

### Pediatrics[edit]

While the packaging of melatonin often warns against use in children, at least one long-term study does assess effectiveness and safety in children. No serious safety concerns were noted in any of the 94 cases studied by means of a structured questionnaire for the parents. With a mean follow-up time of 3.7 years, long-term medication was effective against sleep onset problems in 88% of the cases.[59]

## Medical uses[edit]

A bottle of melatonin tablets

Melatonin has been studied as a potential treatment of gastroesophageal reflux disease,[60] cancer, immune disorders, cardiovascular diseases, depression, seasonal affective disorder (SAD), circadian rhythm sleep disorders, sexual dysfunction[citation needed] and some forms of insomnia.[which?][61][62][63] Prolonged release melatonin has shown good results in treating insomnia in older adults (2007).[64] It may ameliorate circadian misalignment and SAD.[65][unreliable medical source?] Basic research indicates that melatonin may play a significant role in modulating the effects of drugs of abuse such as cocaine.[66][unreliable medical source?] Melatonin is also a geroprotector.[67]

A 2004 review found that melatonin significantly increased total sleep time in people suffering from sleep restriction.[29]

For many types of sleep disorders, melatonin is not effective. A 2006 review found that although it is safe for short term use (of three months or less), there is "no evidence that melatonin is effective in treating secondary sleep disorders or sleep disorders accompanying sleep restriction, such as jet lag and shiftwork disorder."[68]

In a 2005 study, researchers concluded that while "there is some evidence to suggest that melatonin is effective in treating delayed sleep phase syndrome, ...there is evidence to suggest that melatonin is not effective in treating most primary sleep disorders with short-term use (4 weeks or less)."[69]

### Circadian rhythm disorders[edit]

Further information: Circadian rhythm

Exogenous melatonin taken in the evening is, together with light therapy upon awakening, the standard treatment for delayed sleep phase syndrome (DSPS) and non-24-hour sleep-wake syndrome where circadian rhythms are not entrained to the environmental cycle. It appears to have some use against other circadian rhythm sleep disorders as well, such as jet lag and the problems of people who work rotating or night shifts. Melatonin reduces sleep onset latency to a greater extent in people with DSPS than in people with insomnia.[29]

A very small dose taken several hours before bedtime in accordance with the phase response curve for melatonin in humans (PRC) doesn't cause sleepiness but, acting as a chronobiotic (affecting aspects of biological time structure),[70] advances the phase slightly and is additive to the effect of using light therapy upon awakening. Light therapy may advance the phase about one to two-and-a-half hours and a small oral dose of melatonin, timed correctly some hours before bedtime, can add about 30 minutes to the ~2 hour advance achieved with light therapy.[71]

The World Health Organization in 2007 named late night shift work as a probable cancer-causing agent.[72] Melatonin is an anti-oxidant and suppressant of tumor development that is produced at night; when someone works in artificial light, they generally have lower melatonin and may be more likely to develop cancer. Melatonin supplements may simulate the melatonin production at different times that does not occur during regular sleeping hours for people who work night shifts.[72]

### Learning, memory and Alzheimer's[edit]

Melatonin receptors appear to be important in mechanisms of learning and memory in mice,[73] and melatonin can alter electrophysiological processes associated with memory, such as long-term potentiation (LTP). Brain-derived neurotrophic factor (BDNF), its production stimulated by melatonin, is an braincell adaptogenic that helps prevent mental regression.[74] The first published evidence that melatonin may be useful in Alzheimer's disease was the demonstration that this neurohormone prevents neuronal death caused by exposure to the amyloid beta protein, a neurotoxic substance that accumulates in the brains of patients with the disorder.[75] Melatonin also inhibits the aggregation of the amyloid beta protein into neurotoxic microaggregates that, it seems, underlie the neurotoxicity of this protein, causing death of neurons and formation of neurofibrillary tangles, the other neuropathological landmark of Alzheimer's disease.[76]

Melatonin has been shown to prevent the hyperphosphorylation of the tau protein in rats. Hyperphosphorylation of tau protein can also result in the formation of neurofibrillary tangles. Studies in rats suggest that melatonin may be effective for treating Alzheimer's disease.[77] These same neurofibrillary tangles can be found in the hypothalamus in patients with Alzheimer's, adversely affecting their bodies' production of melatonin. Another study has implicated heightened afternoon agitation found in many Alzheimer's patients, called sundowning, with a phase delay in core body temperature.[78] This may suggest a possible connection to melatonin production.

### Delirium[edit]

A randomized placebo-controlled trial showed that low-dose melatonin supplementation to 72 elderly patients admitted to acute medicine services significantly reduced delirium.[79]

### Stimulants[edit]

Research shows that after melatonin is administered to ADHD patients on methylphenidate, the time needed to fall asleep is significantly reduced. Furthermore, the effects of the melatonin after three months showed no change from its effects after one week of use.[80]

### Headaches[edit]

Several clinical studies indicate that supplementation with melatonin is an effective preventive treatment for migraines and cluster headaches.[81][82]

### Mood disorders[edit]

Melatonin has been shown to be effective in treating seasonal affective disorder,[83] a form of depression, and is being considered for bipolar and other disorders in which circadian disturbances are involved.[84] It was observed in 1985 that bipolar disorder might have elevated sensitivity to light, i.e., a greater decrease in melatonin secretion in response to light exposure at night, as a "trait marker" (a characteristic of being bipolar, which does not change with state).[85] This could be contrasted with drug-free recovered bipolar patients showing normal light sensitivity.[86]

### Cancer[edit]

A systematic review of unblinded clinical trials involving a total of 643 cancer patients using melatonin found a reduced incidence of death.[87] Another clinical trial is due to be completed in 2012.[88][dated info] Modelling predicts that melatonin levels at night are reduced to 50% by exposure to a low-level incandescent bulb for only 39 minutes.[89] Studies have shown that melatonin prevents DNA fragmentation in brain tissue caused by dexamethasone neurotoxicity in mice, it is hypothesized it has similar affects on the human brain. [90] Melatonin is hypothesized to inhibit breast cancer causing fibroblasts as the main metabolite of melatonin is statistically significantly linked to lower risk of developing breast cancer. [91] It has been suspected that women with the brightest bedrooms have an increased risk for breast cancer.[92] Reduced melatonin production has been proposed as a likely factor in the significantly higher cancer rates in night workers.[93]

### Gallbladder stones[edit]

Melatonin presence in the gallbladder has many protective properties, such as converting cholesterol to bile, preventing oxidative stress, and increasing the mobility of gallstones from the gallbladder.[94] It also decreases the amount of cholesterol produced in the gallbladder by regulating the cholesterol that passes through the intestinal wall. In guinea pigs, melatonin administration restored normal function by reducing inflammation after induced cholecystitis, whether administered before or after onset of inflammation.[94] Concentration of melatonin in the bile is 2?3 times higher than the otherwise very low daytime melatonin levels in the blood across many diurnal mammals, including humans.[95]

### Amyotrophic lateral sclerosis[edit]

In animal models, melatonin has been shown to ameliorate glutamate-induced neuronal death, it is presumed due to its antioxidant effects. In a clinical safety study involving 31 ALS patients, high-dose rectal melatonin (300?mg/day for 2 years) was shown to be tolerated well.[96]

### Obesity[edit]

Melatonin is involved in energy metabolism and body weight control in small animals. Many studies show that chronic melatonin supplementation in drinking water reduces body weight and abdominal fat in experimental animals, especially in the middle-aged rats[97] and the weight loss effect did not require the animals to eat less and to be physically more active. A potential mechanism is that melatonin promotes the recruitment of brown adipose tissue (BAT) as well as enhances its activity.[98] This effect would raise the basal metabolic rate by stimulating thermogenesis, heat generation through uncoupling oxidative phosphorylation in mitochondria. Whether the results of animal studies can be extrapolated to human obesity is a matter of future clinical trials, since substantially active BAT has been identified in adult humans.[citation needed]

### Protection from radiation[edit]

Both animal[99] and human[100][101] studies have shown melatonin to be potentially radioprotective. Moreover, it is a more efficient protector than amifostine,[102] a commonly used agent for this purpose. The mechanism of melatonin in protection against ionizing radiation is thought to involve scavenging of free radicals.[36] It is estimated that nearly 70% of biological damage caused by ionizing radiation is attributable to the free radical, especially the hydroxyl radical that attacks DNA, proteins, and cellular membranes. Melatonin has been suggested as a radioprotective agent, with the proposed advantages of being broadly protective, readily available, orally self-administered, and without major known side effects.[103]

### Tinnitus[edit]

Several medical studies involving adult patients indicate that melatonin can be beneficial in the treatment of tinnitus.[104][105][106][107]

### Other[edit]

Melatonin was used to treat periodic limb movement disorder, a common neurological condition, which, when severe, adversely affects sleep and causes excessive daytime fatigue, in a small trial conducted by Kunz D and Bes F. In this condition, the sufferer is affected by mini arousals during sleep and limb movements that occur in a frequent rhythmic fashion. This often involves leg kicking, but sometimes also involves arm movement. Those affected are often not aware of the condition, and partners are often the first to notice the condition. 7 out of the 9 participants in the trial showed significant improvement.[108]

In recent trial for use in irritable bowel syndrome treatment, melatonin relieved some symptoms, as published in 2010.[109]

## Adverse effects[edit]

Melatonin appears to cause very few side-effects in the short term, up to three months, when healthy people take it at low doses. A systematic review[68] in 2006 looked specifically at efficacy and safety in two categories of melatonin usage: first, for sleep disturbances that are secondary to other diagnoses and, second, for sleep disorders such as jet lag and shift work that accompany sleep restriction.[68]

The study concluded that There is no evidence that melatonin is effective in treating secondary sleep disorders or sleep disorders accompanying sleep restriction, such as jet lag and shiftwork disorder. There is evidence that melatonin is safe with short term use.[68]

Melatonin should not be taken by children as it can lead to serious developmental effects in children under 13 years of age.[citation needed] A research team in Italy has found that melatonin increased the chances of some cancers including lymphoma in children under the age of 10 years old.[citation needed]

A similar analysis[69] by the same team a year earlier on the efficacy and safety of exogenous melatonin in the management of primary sleep disorders found that: There is evidence to suggest that melatonin is safe with short-term use (3 months or less).

Unwanted effects in some people especially at high doses (~3?mg/day or more) may include headaches, nausea, next-day grogginess, irritability, hormone fluctuations, vivid dreams, nightmares,[110] reduced blood flow and hypothermia.[111]

While no large, long-term studies that might reveal side-effects have been conducted, there do exist case reports about patients having taken melatonin for months.[112]

Melatonin can cause somnolence (drowsiness), and, therefore, caution should be shown when driving, operating machinery, etc.

In individuals with auto-immune disorders, there is conflicting evidence whether melatonin supplementation may either ameliorate or exacerbate symptoms due to immunomodulation.[113][114]

Individuals experiencing orthostatic intolerance, a cardiovascular condition that results in reduced blood pressure and blood flow to the brain when a person stands, may experience a worsening of symptoms when taking melatonin supplements, a study at Penn State College of Medicine's Milton S. Hershey Medical Center suggests. Melatonin can exacerbate symptoms by reducing nerve activity in those experiencing the condition, the study found.[115]

A research team in Italy has found that melatonin supplementation in the evening in perimenopausal women produces an improvement in thyroid function and gonadotropin levels, as well as restoring fertility and menstruation and preventing the depression associated with the menopause.[116] One study reported that melatonin taken in the evening raised prolactin levels in six out of seven women.[117] Melatonin has been found to lower FSH levels.[118] Effects of the hormone on human reproduction remain unclear,[119] although it was with some effect tried as a contraceptive in the 1990s.[120]

Melatonin was thought to have a very low maternal toxicity in rats.[121] Newer studies, though, have found that it is toxic to photoreceptor cells in rats' retinas[122] and increases tumours in white mice.[123][124]

## Availability[edit]

Legal availability of melatonin varies in different countries, ranging from being available without prescription (e.g. in most of North America) to being available only on prescription or not at all (although its possession and use may not be illegal). In the UK it is available on prescription only.

The hormone may be administered orally, as capsules, tablets or liquid, sublingually, or as transdermal patches.

The use of melatonin derived from animal pineal tissue may carry the risk of contamination or the means of transmitting viral material. The synthetic form of this medication does not carry this risk.[4][125]

### Dietary supplement[edit]

In the USA, because it is sold as a dietary supplement, sometimes combined with other ingredients, such as vitamins and herbal extracts, and not as a drug, the Food and Drug Administration (FDA) regulations that apply to medications are not applicable to melatonin.[4] However, new FDA rules required that by June 2010 all production of dietary supplements must comply with "current good manufacturing practices" (cGMP), and be manufactured with "controls that result in a consistent product free of contamination, with accurate labeling."[126] In addition, the industry has been required to report to the FDA "all serious dietary supplement related adverse events" and the FDA has, within the cGMP guidelines, begun enforcement of that requirement.[citation needed]

### Food products[edit]

As reported in the New York Times in May 2011,[127] melatonin is sold in grocery stores, convenience stores, and clubs in both beverage and snack forms. The FDA is considering whether these food products can continue to be sold with the label "dietary supplements". On January 13, 2010, they issued a warning letter to Innovative Beverage, creators of several beverages marketed as "relaxation drinks," stating that melatonin is not approved as a food additive because it is not generally recognized as safe.[128]

### Prolonged release[edit]

Circadin 2mg, prolonged-release melatonin

Melatonin is available as a prolonged-release prescription drug, trade-name Circadin, manufactured by Neurim Pharmaceuticals. The European Medicines Agency (EMA) has approved Circadin 2?mg (prolonged-release melatonin) for patients aged 55 or over, as monotherapy for the short-term treatment (up to 13 weeks) of primary insomnia characterized by poor quality of sleep.[129]

## History[edit]

Melatonin is related to the mechanism by which some amphibians and reptiles change the color of their skin and, indeed, it was in this connection the substance first was discovered.[130][131] As early as 1917, Carey Pratt McCord and Floyd P. Allen discovered that feeding extract of the pineal glands of cows lightened tadpole skin by contracting the dark epidermal melanophores.[14][132] In 1958 dermatology professor Aaron B. Lerner and colleagues at Yale University, in the hope that a substance from the pineal might be useful in treating skin diseases, isolated the hormone from rat urine[133] and named it melatonin.[134] In the mid-70s Lynch et al. demonstrated[135] that the production of melatonin exhibits a circadian rhythm in human pineal glands. The discovery that melatonin is an antioxidant was made in 1993.[136] The first patent for its use as a low dose sleep aid was granted to Richard Wurtman at MIT in 1995.[137] Around the same time, the hormone got a lot of press as a possible treatment for many illnesses.[138] The New England Journal of Medicine editorialized in 2000: "The hype and the claims of the so-called miraculous powers of melatonin several years ago did a great disservice to a scientific field of real importance to human health. (...) Our 24-hour society, with its chaotic time cues and lack of natural light, may yet reap substantial benefits."[139]

## See also[edit]

| Wikimedia Commons has media related to API.

- Ramelteon
- 5-Methoxytryptamine
- Agomelatine
- Tasimelteon
- Risks and benefits of sun exposure
- Discovery and development of melatonin receptor agonists

## References[edit]

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## Further reading[edit]

- Wade AG, Ford I, Crawford G, McConnachie A, Nir T, Laudon M, Zisapel N (2010). "Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: a randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety". BMC Med 8: 51. doi:10.1186/1741-7015-8-51. PMC 2933606. PMID 20712869.

## External links[edit]

- Melatonin entry in TiHKAL ? info

Melatonergics
Receptor ligands |
Agonists | Agomelatine LY-156,735 Melatonin NAS (Normelatonin) Ramelteon Tasimelteon
Antagonists | Afobazole Luzindole Prazosin (at MT3)
Enzyme inhibitors |
Anabolism |
AANAT inhibitors |
ASMT inhibitors |
Catabolism |
Others |
Precursors | L-Tryptophan → 5-HTP → Serotonin → NAS (Normelatonin)
Cofactors | Ferrous Iron (Fe2+) Magnesium (Mg2+) S-Adenosyl-L-methionine Tetrahydrobiopterin Vitamin B3 (Niacin nicotinamide → NADPH) Vitamin B6 (Pyridoxine Pyridoxamine Pyridoxal → Pyridoxal phosphate) Vitamin B9 (Folic acid → Tetrahydrofolic acid) Vitamin C (Ascorbic acid) Zinc (Zn2+)

Neurotransmitters
Amino acids | Alanine Aspartate Cycloserine DMG GABA Glutamate Glycine Hypotaurine Kynurenic acid (Transtorine) NAAG (Spaglumic acid) NMG (Sarcosine) Serine Taurine TMG (Betaine)
Endocannabinoids | 2-AG 2-AGE (Noladin ether) AEA (Anandamide) NADA OAE (Virodhamine) Oleamide PEA (Palmitoylethanolamide) RVD-Hpα Hp (Hemopressin)
Gasotransmitters | Carbon monoxide Hydrogen sulfide Nitric oxide Nitrous oxide
Monoamines | Dopamine Epinephrine (Adrenaline) Melatonin NAS (Normelatonin) Norepinephrine (Noradrenaline) Serotonin (5-HT)
Purines | Adenosine ADP AMP ATP
Trace amines | 3-ITA 5-MeO-DMT Bufotenin DMT m-Octopamine p-Octopamine m-Tyramine p-Tyramine NMT Phenethylamine Synephrine Thyronamine Tryptamine
Others | 1,4-BD Acetylcholine GBL GHB Histamine
See also Template:Neuropeptides
M: PNS | anat (h/r/t/c/b/l/s/a)/phys (r)/devp/prot/nttr/nttm/ntrp | noco/auto/cong/tumr, sysi/epon, injr | proc, drug (N1B)

Antioxidants
Food antioxidants | Acetyl-L-Carnitine (ALCAR) Alpha-Lipoic Acid (ALA) Ascorbic Acid (Vitamin C) Carotenoids (Vitamin A) Curcumin Edaravone Polyphenols Glutathione Hydroxytyrosol L-Carnitine Ladostigil Melatonin Mofegiline N-Acetylcysteine (NAC) N-Acetylserotonin (NAS) Oleocanthal Oleuropein Rasagiline Resveratrol Selegiline Selenium Tocopherols (Vitamin E) Tocotrienols (Vitamin E) Tyrosol Ubiquinone (Coenzyme Q) Uric Acid
Fuel antioxidants | Butylated hydroxytoluene 2,6-Di-tert-butylphenol 1,2-Diaminopropane 2,4-Dimethyl-6-tert-butylphenol Ethylenediamine
Measurements | Folin method ORAC TEAC FRAP

Dietary supplements
Types | Amino acids Bodybuilding supplement Energy drink Energy bar Fatty acids Herbal Supplements Minerals Prebiotics Probiotics (Lactobacillus Bifidobacterium) Protein bar Vitamins
Vitamins and "minerals" (chemical elements) | Retinol (Vitamin A) B vitamins: Thiamine (B1) Riboflavin (B2) Niacin (B3) Pantothenic acid (B5) Pyridoxine (B6) Biotin (B7) Folic acid (B9) Cyanocobalamin (B12) Ascorbic acid (Vitamin C) Ergocalciferol and Cholecalciferol (Vitamin D) Tocopherol (Vitamin E) Naphthoquinone (Vitamin K) Calcium Choline Chromium Cobalt Copper Fluorine Iodine Iron Magnesium Manganese Molybdenum Phosphorus Potassium Selenium Sodium Sulfur Zinc
Other common ingredients | AAKG Carnitine Chondroitin sulfate Cod liver oil Copper gluconate Creatine/Creatine supplements Dietary fiber Echinacea Elemental calcium Ephedra Fish oil Folic acid Ginseng Glucosamine Glutamine Grape seed extract Guarana Iron supplements Japanese Honeysuckle Krill oil Lingzhi Linseed oil Lipoic acid Milk thistle Melatonin Red yeast rice Royal jelly Saw palmetto Spirulina St John's wort Taurine Wheatgrass Wolfberry Yohimbine Zinc gluconate
Related articles | Codex Alimentarius Enzyte Hadacol Nutraceutical Multivitamin Nutrition Tisane

Endocrine system: hormones (Peptide hormones · Steroid hormones)
Endocrine glands |
Hypothalamic- pituitary |
Hypothalamus | GnRH · TRH · Dopamine · CRH · GHRH/Somatostatin · Melanin concentrating hormone
Posterior pituitary | Vasopressin · Oxytocin
Anterior pituitary | α (FSH FSHB, LH LHB, TSH TSHB, CGA) · Prolactin · POMC (CLIP, ACTH, MSH, Endorphins, Lipotropin) · GH
Adrenal axis | Adrenal cortex: aldosterone · cortisol · DHEA Adrenal medulla: epinephrine · norepinephrine
Thyroid axis | Thyroid: thyroid hormone (T3 and T4) · calcitonin Parathyroid: PTH
Gonadal axis | Testis: testosterone · AMH · inhibin Ovary: estradiol · progesterone · activin and inhibin · relaxin (pregnancy) Placenta: hCG · HPL · estrogen · progesterone
Islet-Acinar Axis | Pancreas: glucagon · insulin · amylin · somatostatin · pancreatic polypeptide
Pineal gland | Pineal gland: melatonin
Non-end. glands | Thymus: Thymosin (Thymosin α1, Thymosin beta) · Thymopoietin · Thymulin Digestive system: Stomach: gastrin · ghrelin · Duodenum: CCK · Incretins (GIP, GLP-1) · secretin · motilin · VIP · Ileum: enteroglucagon · peptide YY · Liver/other: Insulin-like growth factor (IGF-1, IGF-2) Adipose tissue: leptin · adiponectin · resistin Skeleton: Osteocalcin Kidney: JGA (renin) · peritubular cells (EPO) · calcitriol · prostaglandin Heart: Natriuretic peptide (ANP, BNP)
M: END | anat/phys/devp/horm | noco (d)/cong/tumr, sysi/epon | proc, drug (A10/H1/H2/H3/H5)

Hypnotics/sedatives (N05C)
GABAA agonists/PAMs | Alcohols: 2M2B • Chloralodol • Ethanol (Alcohol) • Ethchlorvynol • Methylpentynol • Trichloroethanol Barbiturates: Allobarbital • Amobarbital • Aprobarbital • Barbital • Butabarbital • Butobarbital • Cyclobarbital • Ethallobarbital • Heptabarb • Hexobarbital • Mephobarbital • Methohexital • Pentobarbital • Phenallymal • Phenobarbital • Propylbarbital • Proxibarbal • Reposal • Secobarbital • Talbutal • Thiamylal • Thiopental • Vinbarbital • Vinylbital Benzodiazepines: Brotizolam • Cinolazepam • Climazolam • Doxefazepam • Estazolam • Flunitrazepam • Flurazepam • Flutoprazepam • Haloxazolam • Loprazolam • Lormetazepam • Midazolam • Nimetazepam • Nitrazepam • Quazepam • Temazepam • Triazolam Carbamates: Carisoprodol • Ethinamate • Hexapropymate • Meprobamate • Methocarbamol • Procymate • Tybamate Neuroactive Steroids: Acebrochol • Allopregnanolone • Alphadolone • Alphaxolone • Eltanolone • Ganaxolone • Hydroxydione • Minaxolone • Org 20599 • Org 21465 • Tetrahydrodeoxycorticosterone Nonbenzodiazepines: CL-218,872 • Eszopiclone • Indiplon • JM-1232 • Lirequinil • Necopidem • Pazinaclone • ROD-188 • Saripidem • Suproclone • Suriclone • SX-3228 • U-89843A • U-90042 • Zaleplon • Zolpidem • Zopiclone Phenols: Fospropofol • Propofol Piperidinediones: Glutethimide • Methyprylon • Pyrithyldione • Piperidione Quinazolinones: Afloqualone • Cloroqualone • Diproqualone • Etaqualone • Mebroqualone • Mecloqualone • Methaqualone • Methylmethaqualone • Nitromethaqualone • SL-164 Volatiles/gases: • Acetophenone • Acetylglycinamide chloral hydrate • Centalun • Chloral hydrate • Paraldehyde Others: Bromide (Lithium bromide, Potassium bromide, Sodium bromide) • Chloralose • Clomethiazole • Dichloralphenazone • Etomidate • Gaboxadol • Loreclezole • Metomidate • Org 25435 • Petrichloral • Sulfonmethane • Triclofos • Valerenic acid (Valerian)
GABAB agonists | 1,4-Butanediol • Aceburic acid • GABOB • GHB (Sodium oxybate) • GBL • GVL
H1 inverse agonists | Antihistamines: Captodiame • Cyproheptadine • Diphenhydramine • Doxylamine • Hydroxyzine • Methapyrilene • Pheniramine • Promethazine • Propiomazine Antidepressants: Tricyclic antidepressants (Amitriptyline, Doxepin, Trimipramine, etc.) • Tetracyclic antidepressants (Mianserin, Mirtazapine, etc.) Antipsychotics: Typical antipsychotics (Chlorpromazine, Thioridazine, etc.) • Atypical antipsychotics (Olanzapine, Quetiapine, Risperidone, etc.)
α1-Adrenergic antagonists | Antidepressants: Serotonin antagonists and reuptake inhibitors (Trazodone) • Tricyclic antidepressants (Amitriptyline, Doxepin, Trimipramine, etc.) • Tetracyclic antidepressants (Mianserin) Antipsychotics: Typical antipsychotics (Chlorpromazine, Thioridazine, etc.) • Atypical antipsychotics (Olanzapine, Quetiapine, Risperidone, etc.) Others: Niaprazine
α2-Adrenergic agonists | 4-NEMD • Clonidine • Detomidine • Dexmedetomidine • Lofexidine • Medetomidine • Romifidine • Tizanidine • Xylazine
5-HT2A antagonists | Antidepressants: Serotonin antagonists and reuptake inhibitors (Trazodone) • Tricyclic antidepressants (Amitriptyline, Doxepin, Trimipramine, etc.) • Tetracyclic antidepressants (Mianserin, Mirtazapine, etc.) Antipsychotics: Typical antipsychotics (Chlorpromazine, Thioridazine, etc.) • Atypical antipsychotics (Olanzapine, Quetiapine, Risperidone, etc.) Others: Eplivanserin • Niaprazine • Pruvanserin • Volinanserin
Melatonin agonists | Agomelatine • LY-156,735 • Melatonin • Ramelteon • Tasimelteon
Orexin antagonists | Almorexant • SB-334,867 • SB-408,124 • SB-649,868 • Suvorexant • TCS-OX2-29
Others | Acecarbromal • Apronal • Bromisoval • Cannabidiol (Cannabis) • Carbromal • Embutramide • Evoxine • Fenadiazole • Gabapentin • Kavalactones (Kava) • Mephenoxalone • Opioids (Oxycodone, Morphine (Opium), etc.) • Passion flower • Scopolamine (Mandrake) • UMB68 • Valnoctamide

Antidepressants (N06A)
Specific reuptake inhibitors (RIs), enhancers (REs), and releasing agents (RAs)
Selective serotonin reuptake inhibitors (SSRIs) | Alaproclate Citalopram Escitalopram Femoxetine Fluoxetine# Fluvoxamine Indalpine Ifoxetine Litoxetine Omiloxetine Panuramine Paroxetine Pirandamine Seproxetine Sertraline Zimelidine‡
Serotonin–norepinephrine reuptake inhibitors (SNRIs) | Clovoxamine Desvenlafaxine Duloxetine Levomilnacipran Eclanamine Milnacipran Sibutramine Venlafaxine
Serotonin–norepinephrine–dopamine reuptake inhibitors (SNDRIs) | Adhyperforin Amitifadine Bicifadine Brasofensine BTS-74,398 Cocaine Diclofensine DOV-102,677 DOV-216,303 EXP-561 Fezolamine Hyperforin JNJ-7925476 NS-2359 PRC200-SS Pridefine SEP-225,289 SEP-227,162 Tesofensine
Norepinephrine reuptake inhibitors (NRIs) | Amedalin Atomoxetine/Tomoxetine Binedaline Ciclazindol Daledalin Edivoxetine Esreboxetine Lortalamine Maprotiline Mazindol Nisoxetine Reboxetine Talopram Talsupram Tandamine Viloxazine
Dopamine reuptake inhibitors (DRIs) | Medifoxamine Vanoxerine
Norepinephrine-dopamine reuptake inhibitors (NDRIs) | Amineptine Bupropion/Amfebutamone Cilobamine Manifaxine Methylphenidate Nomifensine Radafaxine Tametraline
Norepinephrine-dopamine releasing agents (NDRAs) | Amphetamine Befuraline Lisdexamfetamine Methamphetamine Phenethylamine Piberaline Tranylcypromine
Serotonin-norepinephrine-dopamine releasing agents (SNDRAs) | 4-Methyl-αMT αET/Etryptamine αMT/Metryptamine
Selective serotonin reuptake enhancers (SSREs) | Tianeptine
Others | Indeloxazine Teniloxazine Tramadol Viqualine
Receptor antagonists and/or reuptake inhibitors
Serotonin antagonists and reuptake inhibitors (SARIs) | Etoperidone Lubazodone Nefazodone Mepiprazole Trazodone
Noradrenergic and specific serotonergic antidepressants (NaSSAs) | Aptazapine Esmirtazapine Mianserin Mirtazapine Setiptiline/Teciptiline
Norepinephrine-dopamine disinhibitors (NDDIs) | Agomelatine
Serotonin modulators and stimulators (SMSs) | Vortioxetine
Others | Tedatioxetine Vilazodone
Heterocyclic antidepressants (bi-, tri-, and tetracyclics)
Bicyclics | Tiazesim Tofenacin
Tricyclics | Amezepine Amineptine Amitriptyline# Amitriptylinoxide Azepindole Butriptyline Cianopramine Clomipramine Cotriptyline Cyanodothiepin Demexiptiline Depramine/Balipramine Desipramine Dibenzepin Dimetacrine Dosulepin/Dothiepin Doxepin Enprazepine Fluotracen Hepzidine Homopipramol Imipramine Imipraminoxide Intriptyline Iprindole Ketipramine Litracen Lofepramine Losindole Mariptiline Melitracen Metapramine Mezepine Naranol Nitroxazepine Nortriptyline Noxiptiline Octriptyline Opipramol Pipofezine Propizepine Protriptyline Quinupramine Tampramine Tianeptine Tienopramine Trimipramine
Tetracyclics | Amoxapine Aptazapine Azipramine Ciclazindol Ciclopramine Esmirtazapine Maprotiline Mazindol Mianserin Mirtazapine Oxaprotiline Setiptiline/Teciptiline
Monoamine oxidase inhibitors (MAOIs)
Nonselective | Irreversible: Benmoxin Carbenzide Cimemoxin Domoxin Echinopsidine Iproclozide Iproniazid Isocarboxazid Mebanazine Metfendrazine Nialamide Octamoxin Phenelzine Pheniprazine Phenoxypropazine Pivalylbenzhydrazine Safrazine Tranylcypromine Reversible: Caroxazone Paraxazone Quercetin
MAOA-Selective | Irreversible: Clorgiline Reversible: Amiflamine Bazinaprine Befloxatone Berberine Brofaromine Cimoxatone Esuprone Eprobemide Harmala Alkaloids (Harmine Harmaline Tetrahydroharmine Harman Norharman, etc) Methylene Blue Metralindole Minaprine Moclobemide Pirlindole Sercloremine Tetrindole Toloxatone Tyrima
MAOB-Selective | Irreversible: Ladostigil Mofegiline Pargyline Rasagiline Selegiline Reversible: Lazabemide Milacemide
Azapirones and other 5-HT1A receptor agonists
Alnespirone Aripiprazole Befiradol Buspirone Eptapirone Flesinoxan Flibanserin Gepirone Ipsapirone Oxaflozane Tandospirone Vilazodone Zalospirone
#WHO-EM ‡Withdrawn from market Clinical trials: †Phase III §Never to phase III
M: PSO/PSI | mepr | dsrd (o, p, m, p, a, d, s), sysi/epon, spvo | proc (eval/thrp), drug (N5A/5B/5C/6A/6B/6D)

Drugs mentioned in TiHKAL
AL-LAD DBT DET DiPT 5-MeO-α-MT DMT 2,α-DMT α,N-DMT DPT EiPT α-ET ETH-LAD Harmaline Harmine 4-HO-DBT 4-HO-DSBT 4-HO-DET 4-HO-DiPT 4-HO-DMT 5-HO-DMT 4-HO-DPT 4-HO-MET 4-HO-MiPT 4-HO-MPT 4-HO-pyr-T Ibogaine LSD MBT 4,5-MDO-DiPT 5,6-MDO-DiPT 4,5-MDO-DMT 5,6-MDO-DMT 5,6-MDO-MiPT 2-Me-DET 2-Me-DMT Melatonin 5-MeO-DET 5-MeO-DiPT 5-MeO-DMT 4-MeO-MiPT 5-MeO-MiPT 5,6-MeO-MiPT 5-MeO-NMT 5-MeO-pyr-T 6-MeO-THH 5-MeO-TMT 5-MeS-DMT MiPT α-MT NET NMT PRO-LAD pyr-T Tryptamine Tetrahydroharmine α,N,O-TMS

Tryptamines
2-Methyl-5-HT 4,5-DHP-DMT 4,5-MDO-DMT 4,5-MDO-DiPT 4-AcO-DALT 4-AcO-DET 4-AcO-DMT 4-AcO-DiPT 4-AcO-NMT 4-AcO-MET 4-AcO-DPT 4-AcO-MiPT 4-HO-DALT 4-HO-DET 4-HO-DiPT 4-HO-DSBT 4-HO-MET 4-HO-MiPT 4-HO-NMT 4-HO-αMT 4-Me-αET 4-Me-αMT 4-MeO-DiPT 4-MeO-DMT 5-BT 5-Bromo-DMT 5-CT 5-Ethoxy-αMT 5-Fluoro-αMT 5-HO-αMT 5-HO-DiPT 5-HTP 5-Ethoxy-DMT 5-Ethyl-DMT 5-Fluoro-DMT 5-Methyl-DMT 5-Methoxytryptamine 5-MeO-7,N,N-TMT 5-Methyl-αET 5-MeO-αET 5-MeO-αMT 5-MeO-DALT 5-MeO-DET 5-MeO-DiPT 5-MeO-DMT 5-MeO-DPT 5-MeO-MALT 5-MeO-MiPT 5-MeO-NBpBrT 5,7-Dihydroxytryptamine 5-(Nonyloxy)tryptamine 6-Fluoro-αMT 7-Methyl-αET 7-Methyl-DMT αET αMT Aeruginascin AL-37350A BW-723C86 Baeocystin Bufotenidine Bufotenin (5-HO-DMT) DALT Desformylflustrabromine DET DiPT DMT DPT Ethocybin EiPT EMDT EPT Ethocin FGIN-127 FGIN-143 Ibogaine Indorenate Iprocin MET MiPT MPT Miprocin Melatonin MS-245 NAS NMT Norbaeocystin Normelatonin O-4310 Oxypertine PiPT Psilocin (4-HO-DMT) Psilocybin (4-PO-DMT) Rizatriptan Serotonin ST-1936 Sumatriptan Tryptamine Tryptophan Yohimbine Yuremamine Zolmitriptan