Alfentanil
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Drug reference
ramelteon
Melatonin Congener · Hypnotic
Melatonin CongenerHypnotic
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
—
not curated
Top interactionssee all 12 →
- AlfentanilSevereDatabaseDDInter
- BenzhydrocodoneSevereDatabaseDDInter
- BuprenorphineSevereDatabaseDDInter
- ButorphanolSevereDatabaseDDInter
Mechanism
Ramelteon is a synthetic tricyclic analogue of melatonin. It binds to both MT1 and MT2 receptors with high affinity. Binding to MT1 receptors promotes the onset of sleep; binding to MT2 receptors shifts the timing of the circadian system.
Indications
Insomnia (specifically difficulties of sleep onset)Transient and chronic insomniasleep onset insomnia
Dosing
- Adult
- An 8-mg tablet be taken about 30 min before bedtime
Pharmacokinetics
Half-life
about 2 h
Bioavailability
less than 2% (significant first-pass metabolism)
Protein binding
82%
Metabolism
largely metabolized by hepatic CYPs 1A2, 2C, and 3A4
Excretion
<0.1%
Side effects
Common
DizzinessNauseaDrowsinessHeadache
Serious
- does not produce usual BZD-like side effects
- free of rebound phenomena on stoppage
- no dependence producing potential noted so far
Drug interactions
Benzhydrocodone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Buprenorphine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Butorphanol
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Codeine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Dextropropoxyphene
Severe
Database
Clinical effect not specified
Source: DDInter
Dezocine
Severe
Database
Clinical effect not specified
Source: DDInter
Dihydrocodeine
Severe
Database
Clinical effect not specified
Source: DDInter
Fentanyl
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Fluvoxamine
Severe
Database
ramelteon AUC increased 189.9-fold.
coadministration generally contraindicate[d] or at least require[s] dosage adjustment.
Source: DDInter
Hydrocodone
Severe
Database
.
Source: DDInter
Hydromorphone
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Other Melatonin Congener drugs
Ask House about ramelteon
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e·Verified: 2026-05-10 · House clinical team