In this episode, I’ll discuss the use of melatonin in ICU patients.
The Society of Critical Care Medicine has published a focused update to its 2018 Pain, Agitation, Delirium, Immobility, and Sleep guidelines. One of the big changes in this update was regarding the author’s recommendations on the use of melatonin. The 2018 guidelines could not make a recommendation for or against melatonin use for sleep disruption in the ICU. However the focused update says:
We suggest administering melatonin over no melatonin in adult patients admitted to the ICU.
The guideline authors analyzed 30 randomized controlled trials involving almost 4000 patients to reach this recommendation. Melatonin reduced the prevalence of delirium with a relative risk ratio of 0.7.
ICU length of stay was also about half a day lower with melatonin use, although this did not translate into a change in the overall length of hospitalization.
Unfortunately, the wide range of melatonin dose regimens used in the studies that were analyzed prevented the guideline authors from coming to a conclusion on what dose to recommend.
Furthermore, the guidelines authors did comment on the possibility that melatonin, being not as well regulated as prescription medications, might be difficult to obtain with a consistent quality. Therefore, they added as a special consideration to their recommendation that ramelteon, a prescription melatonin receptor agonist, might be used to achieve the same effect. 3 of the trials used to support the guideline recommendations did use ramelteon, but it will likely have a much higher acquisition cost than melatonin, and institutions will have to decide on their own whether quality concerns regarding melatonin supplements are worth the added expense of obtaining ramelteon.
The topic in this episode is inspired by an in-depth training available to members of my Hospital Pharmacy Academy. The Hospital Pharmacy Academy is my online membership site that will teach you practical critical care and hospital pharmacy skills you can apply at the bedside so that you can become confident in your ability to save lives and improve patient outcomes. To get immediate access to this and many other resources to help in your practice, go to pharmacyjoe.com/academy.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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