Advances in Therapy

, Volume 26, Issue 6, pp 613–626 | Cite as

Ramelteon: a review of its therapeutic potential in sleep disorders

  • Seithikurippu R. Pandi-Perumal
  • Venkatramanujam Srinivasan
  • D. Warren Spence
  • Adam Moscovitch
  • Rüdiger Hardeland
  • Gregory M. Brown
  • Daniel P. Cardinali
Open Access
Review

Abstract

Ramelteon is a tricyclic synthetic analog of melatonin that acts specifically on MT1 and MT2 melatonin receptors. Ramelteon’s half-life is longer than that of melatonin, being metabolized in the body to four main metabolites, M-I, M-II, M-III, and M-IV. M-II has an affinity to MT1 and MT2 of about one-tenth of the parent compound, but its concentration in the circulation exceeds that of ramelteon by more than an order of magnitude. Ramelteon is effective in decreasing latency to persistent sleep and increasing total sleep time in freely moving monkeys. A number of clinical studies have been undertaken to study the efficacy of ramelteon in subjects with chronic insomnia. In almost all of these studies, ramelteon, in various doses of 4, 8, or 16 mg most commonly, significantly reduced sleep latency and increased sleep duration. Its primary action in sleep promotion is not a generalized gamma-aminobutyric (GABA)-ergic central nervous system depression, but rather it acts as a melatonergic agonist in the suprachiasmatic nucleus (and at other central nervous system sites), from where downstream processes, including GABA-ergic effects, are controlled via the hypothalamic sleep switch. Unlike other commonly prescribed hypnotic drugs, ramelteon is not associated with next morning hangover effects or reductions in alertness, nor has it been shown to cause withdrawal symptoms. The adverse symptoms reported with ramelteon are mild. All long-term investigations that have been carried out support the conclusion that ramelteon is a well tolerated and effective drug for the treatment of insomnia.

Keywords

hypnotic insomnia melatonin ramelteon 

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Copyright information

© Springer Healthcare Communications 2009

Authors and Affiliations

  • Seithikurippu R. Pandi-Perumal
    • 1
  • Venkatramanujam Srinivasan
    • 2
  • D. Warren Spence
    • 3
  • Adam Moscovitch
    • 4
  • Rüdiger Hardeland
    • 5
  • Gregory M. Brown
    • 6
  • Daniel P. Cardinali
    • 7
  1. 1.Somnogen IncNew YorkUSA
  2. 2.Sri Sathya Sai Medical, Educational and Research FoundationKovai Thirunagar CoimbatoreIndia
  3. 3.Sleep and Alertness ClinicTorontoCanada
  4. 4.Canadian Sleep Institute and CSI Research CenterTorontoCanada
  5. 5.Institute of Zoology and AnthropologyUniversity of GoettingenGoettingenGermany
  6. 6.Department of Psychiatry, Faculty of MedicineUniversity of TorontoOakvilleCanada
  7. 7.Departamento de Docencia e Investigación, Facultad de Ciencias MédicasPontificia Universidad Católica ArgentinaBuenos AiresArgentina

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