Re: Question from jxqyz1 - melatonin?

[Guest guest]

In a message dated 1/5/2008 2:16:55 PM Eastern Standard Time, simon.collins@... writes:

Hi JeromeWhat is your source for saying melatonin needs to be stopped because of an interaction with ARVs?I have never heard of this. As melatonin is metabolised by CYP450 1A2 rather than common ARV pathways, further info would be appreciated.Simon

Hi, Simon. I had remembered reading about some problems with melatonin supplements, but it was a few years ago and I have not been able to find the reference on my computer. I spent an hour or so mining Google, but did not find much. I apologize for not researching this further before making the comment. Below is what I HAVE found. Most of what I have found suggests that we don't know of any important interaction between melatonin and ARVs, with one exception below.

http://www.aidsinfosd.com/supplements.htm

We know that certain supplements can interact with medications, causing unwanted side effects or changes in absorption--but there is still much to learn, and even then these supplements are not always regulated well. The following is a partial list of supplements to be cautious with or avoid (If you don't see a supplement you are taking on this list, do not assume it is safe to take):

St. 's Wort: Do not take with ANY protease inhibitor or antidepressant.

Garlic: May slow blood clotting. Do not take if you are on blood thinners or a protease inhibitor. Fresh garlic is okay.

Echinacea: Do not use on a long-term basis with HIV/AIDS; only shown to be helpful for short periods in preventing the cold and flu.

If you have liver problems (such as Hepatitis C), you should avoid: Kava-containing supplements, any supplement with extra iron or vitamin A, saw palmetto, comfrey or various prepackaged Chinese herbal remedies.

Licorice root: In excess, may cause low potassioum levels, fluid retention, diarrhea, or high blood pressure. Do not take for longer than 4-6 weeks, or if you have diabetes or liver disease.

Grapefruit juice: Do not drink grapefruit juice if you are on a protease inhibitor, it can increase blood levels of the drug to dangerous amounts. Other citrus juices are fine.

Certain supplements may interfere with HAART metabolism. These include St. 's Wort, garlic, ginseng, melatonin, milk thistle, geniposide and scullcap.

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http://www.drugs.com/melatonin.html?printable=1

Melatonin

Generic Name: melatonin (meh lah TOE nin)Brand Names:

What is the most important information I should know about melatonin?

The use of melatonin derived from animal pineal tissue may carry the risk of contamination or the means of transmitting viral material. The synthetic form of melatonin does not carry this risk.

Melatonin has not been evaluated by the FDA for safety, effectiveness, or purity. All potential risks and/or advantages of melatonin may not be known. Additionally, there are no regulated manufacturing standards in place for these compounds. There have been instances where herbal/health supplements have been sold which were contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

[the article continues ...]

What other drugs will affect melatonin?

No drugs have been reported to interact with melatonin. Talk to your doctor, pharmacist, or health care provider before taking any prescription or over-the-counter medicines or other herbal/health supplements.

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Here is the one warning that I was able to find. I will continue to research this.

http://www.drugs.com/drug-interactions/melatonin_d04058.html

melatonin is known to interact with the following drugs:

Click on a link below to view Drug-Drug Interactions with melatonin.

Moderate Interactionsatazanavir, grepafloxacin, Raxar, Reyataz,

Interactions between melatonin and Reyataz (atazanavir)

melatonin and atazanavir (Moderate Drug-Drug)

MONITOR: Coadministration with atazanavir may increase the plasma concentrations of drugs that are primarily metabolized by CYP450 1A2 and/or 2C9. The mechanism is decreased clearance due to competitive inhibition of CYP450 1A2 and 2C9 activity by atazanavir.MANAGEMENT: Caution is advised if atazanavir must be used concomitantly with medications that undergo metabolism by CYP450 1A2 and/or 2C9, particularly those with a narrow therapeutic range. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate for some drugs whenever atazanavir is added to or withdrawn from therapy.

Minor InteractionsAlert, Cafcit, Caffedrine, caffeine, caffeine extended release, Keep Alert, Lucidex, mibefradil, Naropin, Naropin Novaplus, Naropin Polyamp, Naropin SDV, No Doz, NoDoz Maximum Strength, Pep-Back Peak Performance, Posicor, ropivacaine, Stat Awake, Stay Alert, Stay Awake, Verv, Vivarin, Wakespan,

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Are there any negative interaction between hiv meds and melatonin?Oct 30, 2003

i am on a regimen of trivizir since apr/02 and viramune jul/03.. ever since i started taking viramune i cant sleep well.. i was wondering if i could take melatonin once in while to catch up on my sleep.. are there any known interactions?

Response from Mr. Vergel

Be careful, your lack of sleep could be the Ziagen in the Trizivir also. Melatonin-HAART interactions have not been looked at, so we do not know. Talk to your doctor about Ambien or Sonata also, they are sleep aids. And do not drink caffeine after 4 pm. Do not take Kava Kava, another supplement that may help with sleep, since it was found to cause liver toxicity.

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Is melatonin safe for HIV positive people?May 20, 2004

Dear Doc,

I noticed that the label on my over-the-counter melatonin advises against anyone with an autoimmune disease using the product. I use it very sparingly, for jet lag a couple times a year for two or three days, but fear even this might be dangerous. I have been undetectable [under 10] for about six years on Trizavir CD4 steady during that time at 500.

Thanks for your time.

Response from Dr. Henry

There is little data on melatonin and possible interactions with HIV meds. I have had scores of patients use it regularly in the setting of treated HIV and have observed no problems so I would expect little difficulty. KH

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I hope this helps. Again, apologies for setting off any alarm bells unnecessarily.

Jerome Start the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

Hey Jerome--You don't need to apologize!! This is absolutely great. The best thing about any time I make a mistake or speak off the cuff (which I think I've done once...perhaps twice?...in my life....urk....) - is JUST this kind of excellent response and opening of discussion.And is right--for those who weren't aware of the aidsmeds.com drug interaction thingie, it's very helpful.It also underscores that reviewing data on the 'net requires JUST the kind of excellent review of the data from reliable sources that Jerome provided. And interesting to see that there is indeed a wealth of data out there. M.