Melatonin is a hormone produced by the pineal gland in the brain. The use of melatonin obtained from animal pineal tissue is not recommended because of the risk of contamination. The synthetic form of melatonin does not carry this risk. However, melatonin is an over-the-counter dietary supplement and has not been evaluated for safety, effectiveness, and purity by the FDA. All of the potential risks and benefits may not be known. Supplements should be purchased from a reliable source to minimize the risk of contamination. Melatonin has been used in treating insomnia, overcoming jet lag, improving the effectiveness of the immune system, and as an antioxidant. The most significant use is for the short-term treatment of insomnia at low doses. Individuals wishing to use melatonin should consult with their primary health care provider or a pharmacist before using the supplement. Possible adverse reactions include headache and depression. Drowsiness may occur within 30 minutes after taking the herb. The drowsiness may persist for an hour or
more, affecting any activity that requires mental alertness, such as driving. Although uncommon, allergic reactions to melatonin have been reported. The supplement should be stopped and emergency care sought if symptoms of an allergic reaction (eg, difficulty breathing, hives, or swelling of lips, tongue, or face) occur.
^Herbal Alert: Valerian
Valerian was originally used in Europe and was brought on the Mayflower to North America. The herb is widely used for its sedative effects in conditions of mild anxiety or restlessness. It is particularly useful in individuals with insomnia. Valerian improves overall sleep quality by shortening the length of time it takes to go to sleep and decreasing the number of nighttime awakenings. It does not cause the adverse reactions common with sedative drugs, such as addiction and "drug hangovers" the morning after taking the herb. Valerian is classified as generally recognized as safe (GRAS) for use in the United States. Valerian is used as a tea, tablet, capsule, or tincture. When valerian is used as an aid to sleep, the herb is taken approximately 1 hour before bedtime. The dose is less if used for anxiety, and the herb can be used in combination with other calming herbs, such as lemon balm or chamomile. It may take 2 to 4 weeks before the full therapeutic effect (ie, improvement of mood and sleep patterns) of the herb occurs. Dosages include the following:
Tea: 1 to 2 cups/day Capsules/tablets: 300 to 500 mg daily Tincture: 1/2 to 1 teaspoon daily Standardized extract: 300 to 400 mg daily
• The Patient Receiving a Sedative or Hypnotic
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