An article from the PCCA by Tricia Heitman, PharmD, PCCA Pharmacy Consultant
Studies show melatonin may relieve sleep disturbance in children with an autism spectrum disorder.
One of the most commonly reported symptoms in children diagnosed with an autism spectrum disorder (ASD) is sleep disturbance. The actual rate of these disturbances in ASD varies, depending on the study, from between 40% and 80%. They may have trouble falling asleep or have trouble staying asleep, combined with prolonged periods of hypersomnia. This is most troublesome for the parents and one aspect that, if improved, may make a great impact in the home. One explanation for this symptom in children with autism is a reduction in the synthesis of melatonin. Melatonin is an endogenous hormone secreted mainly from the pineal gland and is primarily responsible for keeping a normal circadian rhythm. The secretion of melatonin occurs in the evening. Peak nocturnal plasma levels occur around 03:00, followed by a steady decline until morning. In young adults, the peak levels reach approximately 60 pg/mL. Researchers have found that the last enzyme of melatonin synthesis is deleted in several individuals with ASD.1
Hence, melatonin has become one of the most widely studied treatments for autism. One such study using 3 mg melatonin in 18 children with autism or fragile X between the ages of 2 and 15.3 shows positive results. Of the 12 participants that completed the study and the required paperwork, 10 had improved duration and initiation of sleep.2 In a second study, 107 children (2–18 years of age) with a confirmed diagnosis of ASD received doses of melatonin ranging from 0.75 to 6 mg. After completion of the study, 25% reported resolution of sleep disturbances and another 60% reported improvement in sleep.3
Another important role of melatonin that we often overlook is that of antioxidant. Many studies have proven that is a powerful free radical scavenger.4,5 We already know that individuals on the autism spectrum have difficulty removing toxins and have deficits in glutathione, another very important antioxidant.6Therefore, with melatonin supplementation, we not only can improve the patient’s sleep, but also could impact their general health.
As compounders, what can we do to improve the patient’s experience with this medication? As you know, we often need to take into consideration the patient’s allergies and special likes or dislikes. Not all dosage forms will work for every child. Some children may have an aversion to certain textures, colors or flavors. Others may have allergies to certain colors or flavors. You will need to individualize the dosage form to what works best in each situation. Some dosage form options include oral suspensions, sublingual drops, popsicles, rapid dissolve tablets, slow release capsules, and troches. A call to anyone in PCCA’s Pharmacy Consulting Department will help you determine which flavor and dosage form may work best for an individual child. We always are here to help.