Ramelteon has an elimination half-life of one to three hours. It has an active—albeit less potent—metabolite with a half-life of two to five hours that extends its duration of action. Ramelteon is metabolized in the liver primarily through the CYP1A2 system. It has minimal potential for drug-drug interactions. However, there is significant potential interaction with fluvoxamine (Luvox), a major CYP1A2 inhibitor. Use ramelteon with caution in patients with moderate hepatic impairment. The drug is contraindicated in patients with severe hepatic impairment.46,47

The future of insomnia treatment

Other medications that target melatonin receptors are being developed, as are novel non-benzodiazepine hypnotics in controlled-release formulas. In 2005, the NIH State-of-the-Science conference recognized that insomnia is a chronic, potentially lifelong illness. In addition to more public and private research, there is a substantial need for programs directed at educating health-care providers as well as the public on the consequences of this disorder.48,49

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Dr. Pierse is a first-year resident in the department of dentistry and oral and maxillofacial surgery  at the Brooklyn Hospital Center in Brooklyn, N.Y. Dr. Dym is chairman of the department. The authors have no relationships to disclose relating to the content of this article.

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