雷美替胺(Ramelteon)的注意事项和药物相互作用

Ramelteon is a highly selective melatonin receptor agonist and the first prescription hypnotic not included in the list of controlled drugs.

Ramelteon Precautions

1. Severe allergic/anaphylactoid reactions

Angioedema and allergic reactions have been reported. If such reactions occur, do not use the drug again.

2. Diagnosis of comorbid conditions needs to be evaluated

If insomnia persists after 7-10 days of treatment, the patient should be re-evaluated.

3. Abnormal thinking, behavioral changes, and complex behaviors

May include sleepwalking, driving, and hallucinations. Any new behavioral changes should be evaluated immediately.

4. Depression

It may worsen depression or cause suicidal thoughts.

5. Central nervous system effects

After taking the drug, the ability to perform activities that require complete mental alertness, such as operating machinery or driving a motor vehicle, may be impaired.

6. Reproductive system effects

Including reduced testosterone levels and increased prolactin levels, the impact on the developing human reproductive axis is unclear.

7. Patients with severe sleep apnea

It is not recommended to use ramelteon in this group of people.

The pictures are from public channels (such as the official website of the FDA, the official website of the original drug manufacturer, etc.) and are for reference only.

Ramelteon drug interactions

1. Rifampin (a strong CYP enzyme inducer)

will reduce the exposure of ramelteon and weaken its effect.

2. Ketoconazole (a strong CYP3A4 inhibitor)

will increase the AUC of ramelteon, so caution should be used when using it together.

3. Fluconazole (a strong CYP2C9 inhibitor)

will increase the systemic exposure of ramelteon, so caution should be used when using it together.

4. Donepezil

It will increase the systemic exposure of ramelteon. When ramelteon and donepezil are used together, patients should be closely monitored.

5. Doxepin

It will increase the systemic exposure of ramelteon. When ramelteon and doxepin are used together, patients should be closely monitored.

6. Alcohol

can aggravate the impairment of psychomotor function and should not be used together.

Ramelteon (Ramelteon) medication for special populations

1. Pediatric use

The safety and effectiveness have not been established.

2. Use in the elderly population

There is generally no difference in safety and effectiveness between elderly patients and younger adult subjects.

3. Patients with hepatic insufficiency

It is not recommended for patients with severe hepatic insufficiency. Patients with moderate hepatic insufficiency should use it with caution.