Treatment for Melatonin Overdose
Melatonin overdose generally requires only supportive care and monitoring as it has low toxicity potential, with most patients recovering completely within 24-32 hours without specific interventions.
Clinical Presentation of Melatonin Overdose
Melatonin overdose typically presents with:
- Excessive drowsiness and lethargy
- Disorientation and confusion
- Minimal responsiveness (in severe cases)
- Possible headache and dizziness
- Hypothermia (less common)
Management Algorithm
1. Initial Assessment and Stabilization
- Assess airway, breathing, and circulation
- Obtain vital signs (monitor for hypothermia)
- Perform neurological assessment (including Glasgow Coma Scale)
2. Diagnostic Evaluation
- Complete blood count (may show elevated leukocyte count) 1
- Liver and renal function tests
- Toxicology screen (to rule out co-ingestion of other substances)
- Consider ECG to rule out cardiac effects
3. Treatment Approach
- Supportive care is the mainstay of treatment
- Gastric lavage if presentation is within 1-2 hours of ingestion 1
- IV fluids if needed
- Monitor vital signs until resolution of symptoms
- No specific antidote is required
4. Special Considerations
- Co-ingestion with other medications: Pay particular attention to co-ingestion with benzodiazepines or other CNS depressants, which may potentiate sedative effects 1, 2
- Monitoring period: Most patients recover within 24-32 hours 1
Prognosis and Follow-up
The prognosis for melatonin overdose is excellent, with most patients experiencing complete recovery without sequelae. In a documented case of significant overdose (900mg), the patient regained consciousness after 32 hours without specific interventions beyond supportive care 1.
Important Clinical Caveats
- Melatonin has a relatively benign safety profile compared to other sleep medications 3
- Adverse events are generally mild and include daytime sleepiness (1.66%), headache (0.74%), dizziness (0.74%), and hypothermia (0.62%) 4
- Melatonin may interact with benzodiazepines, potentially enhancing sedative effects 2
- There are reports that naloxone and flumazenil may antagonize some effects of melatonin, but these are not routinely recommended for melatonin overdose 2
Prevention Strategies
After recovery, consider:
- Psychiatric evaluation if overdose was intentional
- Education about proper melatonin dosing (typically 1-5mg for adults) 3
- Discussion about safer alternatives for sleep management
- Assessment for underlying sleep disorders that may have led to self-medication
While melatonin is generally considered safe even at higher doses, healthcare providers should be aware that it is pharmacologically active and should not be considered completely benign in overdose situations 2.