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Unformatted text preview: SIDE EFFECTS How Drug Causes Side Effects • Actions at melatonin receptors that carry over to the next day could theoretically cause daytime sedation, fatigue, and sluggishness, but this is not common Notable Side Effects Sedation Dizziness Fatigue Headache Life Threatening or Dangerous Side Effects • Respiratory depression, especially when taken with other CNS depressants in overdose Weight Gain • Reported but not expected Sedation • Many experience and/or can be significant in amount • May experience sedation or sleepiness immediately after dosing, but not commonly after awakening from a night’s sleep What To Do About Side Effects • Wait • To avoid problems with memory, only take ramelteon if planning to have a full night's sleep • Lower the dose • Switch to a non-benzodiazepine sedative hypnotic RAMELTEON THERAPEUTICS Brands • Rozerem see index for additional brand names Generic? No Class • Melatonin 1 and 2 receptor agonist Commonly Prescribed For (bold for FDA approved) • Insomnia (difficulty with sleep onset) • Primary insomnia • Chronic insomnia • Transient insomnia • Insomnia associated with shift work, jet lag, or circadian rhythm disturbances How The Drug Works • Binds selectively to melatonin 1 and melatonin 2 receptors as a full agonist How Long Until It Works • Generally takes effect in less than an hour If It Works • Reduces time to sleep onset • Increases total sleep time • May improve quality of sleep If It Doesn’t Work • If insomnia does not improve after 7-10 days, it may be a manifestation of a primary psychiatric or physical illness such as obstructive sleep apnea or restless leg syndrome, which requires independent evaluation • Increase the dose • Improve sleep hygiene • Switch to another agent Best Augmenting Combos for Partial Response or Treatment-Resistance • Generally, best to switch to another agent • Eszopiclone, zolpidem • Trazodone • Agents with antihistamine actions (e.g.,• Agents with antihistamine actions (e....
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