What is the recommended bedtime dose of melatonin (melatonin)

Recommended Bedtime Dose of Melatonin

For optimal sleep improvement, melatonin should be dosed based on age and weight: 0.15 mg/kg for children without comorbidities, 3-5 mg for children with psychiatric comorbidities, and 3-5 mg for adults, taken 1.5-2 hours before bedtime. 1

Age-Specific Dosing Recommendations

Children (6-12 years)

• For children without psychiatric comorbidities, the optimal dose is 0.15 mg/kg body weight (approximately 1.6-4.4 mg depending on weight) 2
• For children with psychiatric comorbidities (such as ADHD), use fast-release melatonin at 3 mg if <40 kg or 5 mg if >40 kg 2
• For children with autism spectrum disorders, melatonin at 1-4 mg has shown effectiveness for improving sleep duration, latency, and reducing night wakings 2

Adolescents

• Similar dosing as for children, with 3-5 mg typically being effective 2
• Weight-based approach continues to be appropriate in this age group 1

Adults

• For adults with delayed sleep-wake phase disorder (DSWPD), 5 mg melatonin administered between 19:00-21:00 has shown effectiveness 2
• For REM sleep behavior disorder, doses may range from 3-15 mg 2
• For general insomnia in older adults, lower physiological doses (0.3 mg) may be sufficient to restore sleep efficiency 3

Timing of Administration

• Administer melatonin 1.5-2 hours before habitual bedtime for optimal effect in children 2, 1
• For adults, administration between 19:00-21:00 has shown effectiveness in studies 2
• Recent research suggests that taking melatonin 3 hours before desired bedtime may optimize its sleep-promoting effects 4

Formulation Considerations

• Fast-release melatonin appears more effective than slow-release formulations for sleep onset 2, 5
• The relative ineffectiveness of slow-release melatonin suggests that a short-lived higher peak concentration works better 5
• Choose United States Pharmacopeial Convention Verified formulations when possible for more reliable dosing 1

Safety Profile

• No serious adverse reactions have been documented in relation to melatonin use across age groups 2, 1
• Common side effects may include:
  • Gastrointestinal upset at higher doses 1
  • Morning sleepiness in some individuals 1
• Use with caution in patients taking warfarin or those with epilepsy due to potential interactions 1, 5

Dose Optimization Algorithm

1. Start with lowest effective dose based on age and condition:

   • Children without comorbidities: 0.15 mg/kg 2
   • Children with psychiatric comorbidities: 3 mg (<40 kg) or 5 mg (>40 kg) 2
   • Adults: 3-5 mg 2

2. Administer 1.5-2 hours before desired bedtime 2, 1

3. Assess response after 1-2 weeks 1

4. If ineffective and no adverse effects, consider gradual dose increase within recommended range (up to 15 mg for specific conditions like REM sleep behavior disorder) 2, 1

5. Doses above 5 mg generally appear no more effective for most sleep disorders 5

Important Clinical Considerations

• Melatonin is regulated as a dietary supplement, not a medication, raising concerns about purity and reliability of stated doses 1
• Recent meta-analysis suggests that 4 mg/day may represent the optimal dose for reducing sleep onset latency and increasing total sleep time 4
• The timing of the melatonin dose is important; if taken too early in the day, it may cause sleepiness and delay adaptation to local time 5
• Long-term safety data in children is limited, but available evidence is reassuring 1