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18. DOSAGE:
Melatonin is available in both fast-release and sustained-release forms. Brown et al.
recommend dosages between 2 - 6 total mg per day (50% fast-acting and 50% slow
acting) at bedtime, up to 9 mg per day maximum, which they state usually induces
drowsiness. They caution against doses of over 50 mg per day. For jet lag, they
recommend 5-10 mg of fast-release melatonin just prior to departure.
The Natural Standard notes dosages of 0.5 to 50 mg per day – a wide range -- in the
studies, without any recommendation, or up to 20 mg per day by intramuscular
injection.
Weil recommends 2.5 mg per day, using sublingual tablets.
Fugh-Berman warns that these are high doses, stating that as little as 0.1-0.3 mg may
work for sleep. Mischoulon and Rosenbaum agree. See below.
Mischoulon and Rosenbaum recommend using preparations that use solid dilutants
such as lactose or micro cellulose in addition to preparations that use only oil, which is
absorbed faster but does not stay on the blood as long, since such “fast-release”
melatonin preparations may not sustain adequate serum levels throughout the night.
Thus, as recommended by Brown et al., a combined dosage may be best, but
Mischoulon and Rosenbaum caution that individual rates of melatonin metabolism very
substantially, that older and smaller people are disproportionately affected, and that
adjustment of the dosage is essential to avoid decreased effects in the latter part of the
night due to excessive use of "slow release" melatonin on the one hand or disturbance
of circadian patterns by use of excessive amounts of "fast release" melatonin on the
other.
Since human bodies cannot get meaningful amounts of melatonin from food, but
manufacture it within the body, Mischoulon and Rosenbaum postulate that the aim
should be to mimic normal melatonin levels. This is best done by measuring melatonin
levels in the blood, saliva, or urine in order and supplementing according to the
precise amount of the deficiency found. Mischoulon and Rosenbaum caution that
