A reader (shrinkette) asks "I'm hearing a lot from Rozerem reps these days. I now have a Rozerem pen, a Rozerem mug, and some Rozerem notepads. What is your opinion of Rozerem? Thank you
I have prescribed Rozerem several times, but so far only one of the patients has come back for follow-up. She is taking it for primary insomnia, and seems to be doing well on it. She thinks it is comparable in efficacy to Ambien, which she has taken in the past.
Rozerem acts on 2 of the melatonin receptors (MT1 and MT2) while sparing the peripheral melatonin receptor MT3. Melatonin, which hits all 3 receptors, has the theroetical possibility of interfering with puberty/reproductive functioning because of its effect on MT3. MT1 and MT2 are located mainly in the brain, at the suprachiasmatic nucleus.
Melatonin itself is useful for shifting the biogical clock if given at the proper time. However, it is not a good drug for pure insomnia- it has only about 25 % effectiveness for primary insomnia. Why is Rozerem, a melatonin agonist, effective for insomnia while melatonin isn't?? Nobody knows for sure, but it may be because of increased bioavailabilty or because of its ratio of action at the 2 main melatonin receptors.
From what I've heard, Rozerem is a little less effective for insomnia than the benzodiazepines and the benzo agonists (Ambien, Lunesta, Sonata). But it has a good side effect profile and no risk of addiction. Psychiatrists need to be aware that Luvox (fluvoxamine) raises its levels to 50-70x's normal, and therefore Rozerem and luvox should not be prescribed together.
For more about Rozerem, see this site.
There is a lot we don't know about this novel agent for insomnia. But I can tell you one thing for sure: the Rozerem drug reps are giving out great pens. They are long, wide, and easy to write with.