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Melatonin and Melatonergic Drugs in Clinical Practice pp 343–352Cite as

Melatonergic Drug: Ramelteon and Its Therapeutic Applications in Insomnia

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Abstract

The efficacy of melatonin in promoting and maintaining sleep has been demonstrated in most of the clinical studies. However, because of its short half-life, its sustained effect in improving sleep quality could not be demonstrated uniformly in all the studies that have been undertaken so far. The development of slow-release melatonin preparation Circadin has been found effective in reducing sleep onset time and also for improving sleep quality. This was followed by the introduction of another melatonergic drug ramelteon a melatonin receptor agonist that has high selectivity for MT1 receptors than MT2 receptors and therefore targets sleep onset more specifically than melatonin. Clinical trials undertaken in different countries of European region and Japan have conclusively demonstrated that ramelteon in various doses (from 4 to 32 mg/day) reduced sleep onset latency, increased total sleep time, and sleep efficiency and quality in patients suffering from chronic insomnia. Besides acting as a sedative-hypnotic drug, ramelteon also demonstrated its ability as a drug with chronobiotic properties and has been found useful in resetting the disturbed circadian rhythms. The action of ramelteon in improving sleep efficiency is dose independent and hence acts differently from melatonin. It has a promising value in treating patients with chronic insomnia as it does not have any of the adverse effects like next-day hangover and dependence associated with the usage of other conventional hypnotic drugs.

Keywords

  • Ramelteon
  • Sleep onset latency
  • Total sleep time
  • Sleep efficiency
  • Sleep quality

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Fig. 24.1

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Authors and Affiliations

  1. Sri Sathya Sai Medical Educational and Research Foundation, An International Medical Sciences Research Study Center, Prasanthi Nilayam, 40-Kovai Thirunagar Extn, Goldwins, Coimbatore, TN, 641014, India

    Venkataramanujam Srinivasan MSc, PhD, MAMS

  2. National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini”, ASL 4, Teramo, Italy

    Venkataramanujam Srinivasan MSc, PhD, MAMS

  3. Department of Neuroscience and Imaging, University “G.D’ Annunzio”, Chieti, 66013, Italy

    Venkataramanujam Srinivasan MSc, PhD, MAMS

  4. Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia

    Rahimah Zakaria MBBS, MSc, PhD (Physiology)

  5. Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Mannerheimintie 166, FI-00300, Helsinki, Finland

    Timo Partonen MD, PhD

  6. Department of Psychiatry and Behavioral Sciences, and the Department of Internal Medicine, Neurology Section, Mercer University School of Medicine, 655 First Street, Macon, GA, 31201, USA

    Edward C. Lauterbach MD

  7. Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Preetha Sharone Kuppuswamy MD

  8. Department of Obstetrics and Gynecology, Hadassah Hebrew-University Medical Center, Ein-Kerem, Jerusalem, 91120, Israel

    Amnon Brzezinski MD

  9. Department of Psychiatry, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia

    Zahiruddin Othman MD, MMed (Psychiatry)

  10. Department of Neurology, Dr BL Kapur Superspeciality Hospital, Pusa Road, New Delhi, DL, 110005, India

    Atul Prasad MBBS, DM (Neurology)

Authors
  1. Venkataramanujam Srinivasan MSc, PhD, MAMS
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  2. Rahimah Zakaria MBBS, MSc, PhD (Physiology)
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  7. Zahiruddin Othman MD, MMed (Psychiatry)
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Correspondence to Venkataramanujam Srinivasan MSc, PhD, MAMS .

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Editors and Affiliations

  1. Sri Sathya Sai Medical Educational and Research Foundation, An International Medical Sciences Research Center, Coimbatore, Tamil Nadu, India

    V. Srinivasan

  2. Department of Obstetrics and Gynecology, Hadassah Hebrew-University Medical Center, Jerusalem, Israel

    Amnon Brzezinski

  3. Department of Physiology, Gulhane Military Medical Academy, Ankara, Turkey

    Sukru Oter

  4. Department of Psychiatry Behavioral Sciences, Mercer University School of Medicine, Macon, Georgia, USA

    Samuel D. Shillcutt

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Srinivasan, V. et al. (2014). Melatonergic Drug: Ramelteon and Its Therapeutic Applications in Insomnia. In: Srinivasan, V., Brzezinski, A., Oter, S., Shillcutt, S. (eds) Melatonin and Melatonergic Drugs in Clinical Practice. Springer, New Delhi. https://doi.org/10.1007/978-81-322-0825-9_24

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  • DOI: https://doi.org/10.1007/978-81-322-0825-9_24

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