Supraphysiological oral doses of melatonin can have proconvulsant effects in neurologically disabled children provides valuable additional evidence that such doses should be used with great caution, if at all. The use of melatonin is not supported by the abundant data that would be

required if melatonin were unregulated in the USA as a drug instead of as a dietary supplement. Melatonin seems to exert various effects on the brain and different mechanisms might be involved. Whether neuroprotective in experimental animals or pro-convulsant in human beings, melatonin in supraphysiological doses is widely available, minimally controlled, and used indiscriminately. The role of melatonin in the treatment of sleep-related disorders in both neurologically challenged and non-neurologically challenged individuals requires further investigation.

Lancet 1998; 351: 1254.

COMMENT: Supraphysiological doses of melatonin are readily available in this country and may be purchased as a dietary supplement without prescription. I agree that supplemental melatonin should be used with great caution irrespective of the dose until more is known of its safety and efficacy. I would suggest limiting its use to jet lag only.