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ramelteon (Rozerem)

Not a controlled substance. Indications: - insomnia - sleep onset latency - objective but not subjective improvement in patients with obstructive sleep apnea on CPAP [4] - does not help sleep maintenance - prevention of delirium in hospitalized elderly [3] - case reports of treatment of delirium with ramelteon [5] Dosage: 8 mg QHS Pharmacokinetics: - metabolized by cyt P450 - elimination 1/2life 1.5 hours, 2.6 hours in older adults Laboratory: - ramelteon in tissue - ramelteon in body fluid - ramelteon in blood - ramelteon in serum/plasma - ramelteon in urine Mechanism of action: - melatonin receptor agonist - agonist for melatonin receptor-1 & melatonin receptor-2 [3]

General

receptor agonist

Database Correlations

PUBCHEM cid=208902

References

  1. Prescriber's Letter 12(9): 2005 Comparison of Insomnia Treatments Detail-Document#: 210901 (subscription needed) http://www.prescribersletter.com
  2. Johnson MW, Suess PE, Griffiths RR. Ramelteon: a novel hypnotic lacking abuse liability and sedative adverse effects. Arch Gen Psychiatry. 2006 Oct;63(10):1149-57. PMID: 17015817 - Roth T, Seiden D, Sainati S, Wang-Weigand S, Zhang J, Zee P. Effects of ramelteon on patient-reported sleep latency in older adults with chronic insomnia. Sleep Med. 2006 Jun;7(4):312-8. Epub 2006 May 18. PMID: 16709464 - Erman M, Seiden D, Zammit G, Sainati S, Zhang J. An efficacy, safety, and dose-response study of Ramelteon in patients with chronic primary insomnia. Sleep Med. 2006 Jan;7(1):17-24. Epub 2005 Nov 23. PMID: 16309958
  3. Hatta K et al. Preventive effects of ramelteon on delirium: A randomized placebo-controlled trial. JAMA Psychiatry 2014 Feb 19 PMID: 24554232 http://archpsyc.jamanetwork.com/article.aspx?articleid=1831407
  4. Gooneratne NS, Gehrman P, Gurubhagavatula I et al Effectiveness of ramelteon for insomnia symptoms in older adults with obstructive sleep apnea: a randomized placebo- controlled pilot study. J Clin Sleep Med. 2010 Dec 15;6(6):572-80. PMID: 21206546
  5. Tsuda A, Nishimura K, Naganawa E, Otsubo T, Ishigooka J. Successfully treated delirium in an extremely elderly patient by switching from risperidone to ramelteon. Psychiatry Clin Neurosci. 2013 Feb;67(2):130. PMID: 23438172 - Furuya M, Miyaoka T, Yasuda H et al Marked improvement in delirium with ramelteon: five case reports. Psychogeriatrics. 2012 Dec;12(4):259-62. PMID: 23279149 - Tsuda A, Nishimura K, Naganawa E, Otsubo T, Ishigooka J. Ramelteon for the treatment of delirium in elderly patients: a consecutive case series study. Int J Psychiatry Med. 2014;47(2):97-104. doi: 10.2190/PM.47.2.a. PMID: 25084796