Does melatonin have adverse effects on people with Systemic Lupus Erythematosus (SLE)?

From the Guidelines

Melatonin should be used with caution in people with Systemic Lupus Erythematosus (SLE) as it may potentially worsen symptoms in some patients. This is because melatonin can stimulate the immune system, which is already overactive in autoimmune conditions like lupus. Research suggests that melatonin might increase inflammatory cytokines and autoantibody production, potentially exacerbating lupus flares. If you have SLE and are considering melatonin for sleep issues, it's advisable to start with a very low dose (0.5-1mg) taken 1-2 hours before bedtime, and carefully monitor for any worsening of lupus symptoms such as increased joint pain, fatigue, or rash. Non-hormonal sleep interventions like cognitive behavioral therapy for insomnia, maintaining consistent sleep schedules, and practicing good sleep hygiene may be safer alternatives. Always consult with your rheumatologist before starting melatonin, as individual responses can vary, and your doctor can help weigh the potential benefits against risks based on your specific lupus activity and medication regimen 1.

Some key points to consider:

• The use of melatonin in SLE patients is not well-studied, and more research is needed to fully understand its effects 1.
• The potential benefits of melatonin for sleep issues in SLE patients must be weighed against the potential risks of worsening lupus symptoms 1.
• Non-hormonal sleep interventions may be a safer alternative for SLE patients with sleep issues 1.
• Consultation with a rheumatologist is essential before starting melatonin or any other new medication 1.
• The management of SLE requires a holistic approach, considering the potential effects of treatments on the entire body, not just the kidneys 1.

In terms of specific recommendations, the 2019 update of the EULAR recommendations for the management of SLE suggests that hydroxychloroquine is recommended in all patients with SLE, at a dose not exceeding 5 mg/kg real body weight 1. Additionally, the use of glucocorticoids should be minimized to less than 7.5 mg/day (prednisone equivalent) and, when possible, withdrawn 1. The KDIGO 2021 guideline for the management of glomerular diseases also recommends a holistic approach to the management of LN, considering the potential effects of treatments on the entire body, not just the kidneys 1.

Overall, while melatonin may be a useful treatment for sleep issues in some patients, its use in SLE patients requires caution and careful monitoring due to the potential risks of worsening lupus symptoms. Non-hormonal sleep interventions and consultation with a rheumatologist are essential for SLE patients with sleep issues.

From the Research

Adverse Effects of Melatonin on People with Systemic Lupus Erythematosus (SLE)

• There is evidence to suggest that melatonin may have both positive and negative effects on people with SLE 2.
• A study found that melatonin decreased the production of IL-5 and had a novel role in IL-9 production by human circulating cells 2.
• However, the same study also found that melatonin had a two-faceted effect, acting as an anti-inflammatory compound in healthy subjects, but causing the opposite actions in immune-depressed cells from patients with SLE 2.
• Another study found that serum melatonin levels were significantly lower in patients with SLE compared to healthy controls 3.
• Melatonin has been shown to have a beneficial effect on pristane-induced lupus in mice, regulating cytokine disturbances and lessening renal lesions 4.
• A study found that women with SLE had lower melatonin levels than healthy women, and that melatonin levels were not correlated with laboratory diagnostic criteria parameters or disease activity 5.
• Decreased daily melatonin levels have been observed in women with SLE, and these levels were inversely related to the SLE activity index (SLEDAI) 6.

Key Findings

• Melatonin may have both positive and negative effects on people with SLE, depending on the context and individual response 2, 4.
• Serum melatonin levels are often lower in patients with SLE compared to healthy controls 3, 5, 6.
• Melatonin may have a regulatory effect on cytokine disturbances and disease activity in SLE, but more research is needed to fully understand its effects 2, 4, 5.