I was recently on a podcast hosted by a physician who asked me, “Is melatonin ER (extended release) a thing? I asked in a physician Facebook group and some docs said there’s no use for it.”
I was surprised…yet not surprised.
There are so many misconceptions in the medical community about melatonin and how to use it.
That’s because most of us docs don’t learn how to prescribe it effectively.
Plus, here in the States, it’s OTC (over the counter), so loads of patients take melatonin like a daily multivitamin without really understanding how it works.
It’s now the 4th most popular natural product taken by adults and the 2nd most popular product taken by children in the US.
Melatonin is a hormone produced by the pineal gland in response to darkness.
It’s also known as “the hormone of darkness” and is involved in regulating the sleep-wake cycle.
It exerts its effects through high-affinity G-protein coupled receptors, MT1 and MT2, which are distributed in various brain regions involved in sleep regulation.
Additionally, melatonin can advance the circadian timing of sleep (i.e. help people shift their body clock to fall asleep and wake up earlier).
In fact, we use melatonin strategically in my practice mostly as a body clock regulator to modulate the circadian rhythm, rather than as a sleep aid.
While it’s not indicated for chronic insomnia, melatonin is recommended for sleep issues including but not limited to:
- Circadian rhythm sleep disorders, like delayed sleep phase syndrome, jet lag, etc.
- Children with neurological conditions like autism and ADHD
- REM sleep behavior disorder
Now, what about melatonin ER (extended release)?
There’s a form of melatonin supplements called Circadin.
Circadian is a 2mg extended release melatonin formulation designed to mimic the endogenous pattern of melatonin production.
It’s primarily indicated for the treatment of primary insomnia characterized by poor sleep quality in patients aged 55 years and older.
Now, I said earlier that melatonin is not typically used for chronic insomnia.
However, endogenous melatonin secretion decreases with age, thus melatonin may be helpful in patients over 55.
Circadin is available by prescription in the UK and Australia.
If you’re in the US, you may be surprised to know that in many regions around the world, melatonin is considered a medication and is not available OTC.
In my practice, we do sometimes use extended release melatonin 2mg in our patients over the age of 55 to support sleep, taken 1-2 hours before bed.
So, my answer on the podcast was, “Yes, melatonin ER is a thing.”
But with melatonin, you have to know how to use it effectively…which includes understanding the indications, timing, dosing strategies, quality considerations, and when to stop it.
If you’re ready to use melatonin effectively in your clinical practice, register for the Melatonin Best Practices Masterclass. https://members.intrabalance.com/melatonin-masterclass
It’s a self-guided program where you’ll leave with the knowledge and tools to use melatonin strategically in your practice and enhance patient outcomes.
Sign up here. https://members.intrabalance.com/melatonin-masterclass
References:
Chua HM, Hauet Richer N, Swedrowska M, Ingham S, Tomlin S, Forbes B. Dissolution of Intact, Divided and Crushed Circadin Tablets: Prolonged vs. Immediate Release of Melatonin. Pharmaceutics. 2016 Jan 7;8(1):2. doi: 10.3390/pharmaceutics8010002. PMID: 26751472; PMCID: PMC4810078.
Lemoine P, Zisapel N. Prolonged-release formulation of melatonin (Circadin) for the treatment of insomnia. Expert Opin Pharmacother. 2012 Apr;13(6):895-905. doi: 10.1517/14656566.2012.667076. Epub 2012 Mar 19. PMID: 22429105.
Verma AK, Khan MI, Ashfaq F, Rizvi SI. Crosstalk Between Aging, Circadian Rhythm, and Melatonin. Rejuvenation Res. 2023 Dec;26(6):229-241. doi: 10.1089/rej.2023.0047. Epub 2023 Dec 4. PMID: 37847148.
