Wednesday, December 07, 2005

Rozerem (ramelteon) Update

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.

17 comments:

: Joseph j7uy5 said...

They also are starting to give out nice little Thermos-like containers, perfect for that AM coffee on the way to work.

On a more serious note, there was an a small case series a while back, that suggested that melatonin could cause rapid cycling in patients with bipolar disorder. For that reason, I've been hesitant to use Rozerem in patients with bipolar disorder. I'd be curious to learn if there has been anything new on the potential for MT receptor drugs to exacerbate bipolar disorder.

Michael Rack, MD said...

Thanks for the tip on melatonin possibly inducing rapid cycling; I hadn't heard that before. A quick pub med search reveals several interesting articles on the relationship between melatonin and psychiatric disorders:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11141317&query_hl=1
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10800742&query_hl=1
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10790719&query_hl=1
I hope to look these up when I get the time

FDF said...

Where can I get more information? Your pharmacist has additional information about Propecia written for health professionals that you may read.

FDF said...

Celebrex and may cause dizziness. If you experience drowsiness or dizziness, avoid these activities.(used to treat insomnia), pain relievers, anxiety medicines, seizure medicines, and muscle relaxants. Tell your doctor

FDF said...

Do not take Cialis if you have a history of alcohol or drug abuse; have asthma, bronchitis, emphysema, or another respiratory disease

FDF said...

Take each dose of xanax with a full glass of water. Do not crush, chew, or break the extended-release form xanax XR. Swallow them whole. These tablets are specially formulated to release the medication slowly in the body.

FDF said...

What should I avoid while taking Paxil? Use caution when driving, operating machinery, or performing other hazardous activities. Paxil will cause drowsiness

FDF said...

Do not take more of the medication than is prescribed for you. Naproxen is habit forming. You can become physically and psychologically dependent on the medication. Do not take more than the prescribed amount.

margaret said...

My daughter who is bipolar and obsessive-compulsive has been prescribed both luvox and rozerem by her psychiatrist. Is this safe?

margaret said...

My daughter who is bipolar and obsessive-compulsive has been prescribed both luvox and rozerem by her psychiatrist. Is this safe?

margaret said...

My family member who is bipolar and obsessive compulsive has been prescribed luvox and rozerem by their psychiatrist. Is this safe? (This person also has a strong history of opiate abuse.)

margaret said...

sorry for repetition , just learning how to blog

m said...

I CAN NOT believe this.... I was just switched to Rozerem from Ambien CR 12.5 mg ( i thought it stopped working)And my psychiatrist said it was fine, well i happen to go online to the Rozerem website and it says on the front page in bold writing.....NOT TO TAKE WITH LUVOX. Well, I AM ON LUVOX!!!
How did the Pharmacy not catch this???OR my Doctor??? It says it increases the Rozerem 50 to 70 times then the norm.I can not believe something or someone (angel) told me to look it up before I took the Rozerem, Which was in like 5 minutes!) I will up date you all on what happens, I was told by the Pharmacist to talk to the dispensing Pharmacist. Which happens to be the sweetest lady... Any ideas would be appreciated on how I should pursue this.

m said...

Their website:
http://www.rozerem.com/

Another site: ( think it's the same one as this one) but gives information. That explains what it will do.

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.
Thank god i did not take it!!!
Margaret.... It looks pretty unsafe to me. I hoe your daughter did not take it. Take care.

m said...

http://sleepdoctor.blogspot.com/2005/12/rozerem-ramelteon-update.html
Forgot the link.....

danlamb33 said...

I'm working on a Rozarem regimen right now and it seems to be working. For those of you that are still having problems, I've also found some success with 400mg of Magnesium right before bedtime. Made me very drousy in the middle of the night though if I was getting up for any reason but I was able to go right back to sleep. Rozarem will actually start to build a sleep pattern for you given you take it at the same time every night. Then you can go off of it and back on if your schedule becomes wacky again.

. said...

From someone who has suffered from Delayed Sleep Phase Syndrome for the last 20 years and is now in college having trouble with 8am classes, I had developed debilitating headaches on Ambien. I was switched to Rozerem which initially did zip for me. However, after reading that continued use can contribute to positive effect, I continued taking it for about a week and it now seems to help a LOT. Something about setting your cycle or something.