What is the recommended starting dose for melatonin (melatonin)

Starting Dose for Melatonin

The recommended starting dose for melatonin is 3 mg of immediate-release formulation, taken 30-60 minutes before bedtime. 1

Adult Dosing Algorithm

For most adults with sleep disorders, begin with 3 mg of immediate-release melatonin. 1 The American Academy of Sleep Medicine specifically recommends this starting dose, with titration in 3 mg increments if needed after 1-2 weeks of treatment. 1, 2

Dose Escalation Strategy

• If 3 mg is ineffective after 1-2 weeks, increase by 3 mg increments 2
• Maximum recommended dose is typically 12-15 mg 3, 2
• Lower doses (3-5 mg) are often more effective than higher doses due to receptor desensitization that can occur with doses of 10 mg or higher 2

Special Adult Populations

• For elderly patients (>55 years), prolonged-release melatonin at 2 mg has shown benefit, though evidence quality is considered low 1
• For REM sleep behavior disorder specifically, doses range from 3-12 mg at bedtime 3, 4

Pediatric Dosing Algorithm

For children, dosing depends on the presence of comorbidities:

Children WITHOUT Psychiatric Comorbidities

• Use weight-based dosing: 0.15 mg/kg 1, 2
• Administer 1.5-2.0 hours before habitual bedtime 1, 2
• This typically results in doses of 1.6-4.4 mg 2, 4
• Treatment duration as short as 6 nights has demonstrated effectiveness 1

Children WITH Psychiatric Comorbidities (including autism spectrum disorder)

• Use fixed dosing based on weight: 1, 2
  • 3 mg if <40 kg
  • 5 mg if >40 kg
• Administer at 18:00-19:00 1
• Continue for 4 weeks before assessing efficacy 1

Timing Considerations

Administration timing is critical for effectiveness:

• Take 30-60 minutes before desired bedtime for most sleep disorders 4
• For Delayed Sleep-Wake Phase Disorder specifically, take between 19:00-21:00 1
• Taking melatonin at the wrong time (early in the day) can cause sleepiness and delay adaptation to local time 5

Why Lower Doses May Be Superior

Starting with lower doses (3 mg) is preferable because higher doses can cause receptor desensitization or saturation, potentially disrupting normal circadian signaling. 2 Additionally:

• Morning grogginess and "hangover" effects are more common with higher doses due to melatonin's half-life extending into morning hours 2
• Gastrointestinal upset occurs more frequently at higher doses 2
• Immediate-release formulations are more effective than slow-release for sleep onset 1, 5

Safety Profile and Monitoring

No serious adverse reactions have been documented across age groups at recommended doses. 1, 2 However:

• Use caution in patients taking warfarin or those with epilepsy due to potential interactions 1, 2, 5
• Common mild side effects include morning headache, morning sleepiness, and gastrointestinal upset 3, 2
• Side effects are generally mild and resolve with medication cessation 6

Critical Formulation Considerations

Melatonin is regulated as a dietary supplement in the U.S., raising concerns about purity and reliability of stated doses. 2, 4

• Choose United States Pharmacopeial Convention Verified formulations when possible for more reliable dosing 1, 4
• Melatonin concentration varies widely between product labels and manufacturers 6

Common Pitfalls to Avoid

• Do not start with doses higher than 3-5 mg unless treating specific conditions like REM sleep behavior disorder 1, 2
• Avoid slow-release formulations for sleep onset issues, as immediate-release is more effective 1, 5
• Do not administer too early in the evening (before 19:00 for most patients), as this can worsen circadian misalignment 1, 5
• Do not assume higher doses are better—receptor desensitization makes this counterproductive 2