What is the standard melatonin dose for adults?

Standard Melatonin Dosing for Adults

For adults with sleep disorders, the standard melatonin dose ranges from 1-5 mg taken 1.5-2 hours before bedtime, with 5 mg showing the most consistent benefits for delayed sleep-wake phase disorder (DSWPD). 1

Dosing Recommendations by Condition

For Delayed Sleep-Wake Phase Disorder (DSWPD)

• 5 mg is the recommended dose for adults with DSWPD, taken between 19:00-21:00 (7-9 PM) for a period of 28 days 1
• This timing does not require circadian-based adjustments and has shown positive results in clinical studies 1
• Benefits include decreased sleep latency (by approximately 37-43 minutes) and increased total sleep time 1

For General Insomnia

• For general insomnia treatment, evidence is less supportive of melatonin use 1
• The American Academy of Sleep Medicine suggests that clinicians not use melatonin as a treatment for sleep onset or sleep maintenance insomnia in adults (weak recommendation) 1
• Studies evaluating 2 mg doses in older adults showed insufficient clinical benefits for insomnia 1

Age-Specific Considerations

• For older adults (>55 years), doses of 1-6 mg have been studied, with some evidence suggesting better response in this population 1
• Some studies show that older adults (65-80 years) may experience significant reduction in sleep latency with 2 mg prolonged-release formulations 1
• For adults under 55, the 5 mg dose used in DSWPD studies appears most effective 1

Formulation Considerations

• Both immediate-release and controlled-release formulations are available 2
• Fast-release formulations may be more effective for sleep onset issues 1
• Sustained/controlled-release formulations may help maintain sleep throughout the night 2
• Surge-sustained formulations (25% immediate release + 75% controlled release) attempt to mimic natural melatonin profiles 2

Safety Profile

• Melatonin generally has a good safety profile even at higher doses 3
• Common adverse effects include drowsiness, headache, and dizziness 3
• No serious adverse reactions have been consistently reported in clinical studies 1
• No evidence of dependence has been observed even with long-term use 4

Clinical Application Algorithm

1. Determine the specific sleep disorder:

   • For DSWPD: Use 5 mg taken between 19:00-21:00 1
   • For general insomnia: Consider alternative treatments before melatonin 1

2. Consider patient age:

   • Adults >55 years: May benefit from doses between 1-6 mg 1, 5
   • Adults <55 years with DSWPD: 5 mg dose is recommended 1

3. Select appropriate formulation:

   • Sleep onset difficulties: Fast-release formulation 1
   • Sleep maintenance issues: Consider controlled-release formulation 2

4. Evaluate response after 28 days of consistent use 1

Important Caveats

• The benefits/harms ratio remains uncertain for melatonin use in insomnia 1
• Clinical experience suggests frequent acceptance of melatonin treatment among adults versus no treatment 1
• Melatonin is not FDA-approved for sleep disorders in the US and is sold as a dietary supplement 4
• Melatonin quality and actual content may vary between commercial products 5