What is the recommended dose of melatonin (melatonin) for adults and children?

Melatonin Dosage Recommendations for Adults and Children

For most adults, melatonin should be limited to 1-5 mg taken 1-2 hours before bedtime, while children should receive weight-based dosing starting at lower doses (0.15-0.5 mg/kg) under medical supervision. 1

Adult Dosing Guidelines

General Recommendations

• Standard adult dose: 1-5 mg taken approximately 1-2 hours before bedtime 1
• Maximum recommended dose: 5 mg for most conditions, as higher doses generally do not provide additional benefits 1
• Elderly patients: Start with lower doses (1-2 mg) due to altered metabolism 1

Specific Conditions

• Delayed Sleep-Wake Phase Disorder (DSWPD): 5 mg taken between 7:00-9:00 PM 1
• REM Sleep Behavior Disorder: Start with 3 mg at bedtime, may titrate up to 15 mg if needed 1
• Jet lag prevention: 0.5-5 mg taken at target bedtime (10 PM to midnight) at destination 2

Pediatric Dosing Guidelines

General Considerations

• Medical supervision required: The American Academy of Sleep Medicine recommends consultation with a pediatric sleep specialist 1
• Start low: Begin with lower doses due to children's altered metabolism and increased sensitivity 1

Specific Recommendations

• Children with DSWPD without comorbidities: 0.15 mg/kg taken 1.5-2 hours before habitual bedtime 1
• Children with DSWPD with psychiatric comorbidities: 3-5 mg (weight-based) taken at 18:00 or 19:00 1

Important Clinical Considerations

Formulation Selection

• Sleep onset issues: Use immediate-release melatonin 1
• Sleep maintenance issues: Consider sustained/prolonged-release formulations 1
• Avoid slow-release formulations for jet lag: Short-lived higher peak concentration works better 2

Safety Monitoring

• Common adverse effects: Drowsiness, headache, dizziness at higher doses (≥10 mg) 1, 3
• Special populations requiring caution:
  • Patients with epilepsy (potential for seizure threshold alteration) 1, 2
  • Patients taking warfarin (potential interaction) 1, 2
  • Patients with hepatic impairment (decreased metabolism) 1

Quality Considerations

• Look for USP verification: Ensures stated dose accuracy, as melatonin is regulated as a dietary supplement in the US 1

Efficacy Optimization

• Timing is crucial: Taking melatonin at the wrong time (early in day) can cause sleepiness and delay adaptation 2
• For optimal efficacy: Consider administering 3 hours before desired bedtime at a dose of 4 mg/day 4
• Duration of use:
  • Short-term use (days to weeks) for occasional sleep difficulties 1
  • Long-term use may be necessary for chronic conditions 1

Important Caveat

The American Academy of Sleep Medicine suggests that clinicians not use melatonin as a treatment for sleep onset or sleep maintenance insomnia in adults, based on trials of 2 mg doses 5. However, melatonin remains widely used for circadian rhythm disorders and as an over-the-counter sleep aid.