Usage
- Dehydroepiandrosterone (DHEA) + Melatonin is primarily prescribed for female infertility, specifically in women with diminished ovarian reserve. It may also be used as adjunctive therapy in other infertility treatments like in-vitro fertilization (IVF). Some studies suggest potential benefits for improving sleep quality, particularly in elderly women, and as an antioxidant. It is also marketed for promoting overall physical health.
- Pharmacological classification: This combination includes an endogenous steroid hormone precursor (DHEA) and a neurohormone (Melatonin). DHEA acts as a precursor to androgens and estrogens and can be classified as an endocrine agent. Melatonin is classified as a neurohormone and hypnotic.
- Mechanism of action: DHEA improves female fertility by acting as a precursor to sex hormones, promoting the production of healthy egg cells, and potentially improving oocyte quality. Melatonin’s antioxidant properties protect follicles from oxidative damage, and may further support ovarian function.
Alternate Names
- No widely recognized alternate names exist for this specific drug combination. The individual components are sometimes referred to as prasterone (for DHEA) and N-acetyl-5-methoxytryptamine (for melatonin).
- Brand names: This combination is available under various brand names like Ovacore, Ameova, and is also found in numerous generic formulations. MEM4 is a specific slow-release formulation containing DHEA and Melatonin. “Drone-Q10” is a brand name that combines coenzyme Q10, DHEA, and melatonin.
How It Works
- Pharmacodynamics: DHEA, upon administration, gets converted to androstenedione, which then acts as a precursor for testosterone and estrogen. It binds to androgen and estrogen receptors, influencing various physiological functions including sex hormone balance and reproductive health. Melatonin primarily binds to melatonin receptors MT1 and MT2 in the suprachiasmatic nucleus (SCN) of the hypothalamus, regulating circadian rhythms. It also exhibits antioxidant effects, protecting cells from free radical damage.
- Pharmacokinetics: DHEA is readily absorbed orally and undergoes extensive metabolism in the liver, primarily via sulfation to DHEA-sulfate (DHEAS). It is excreted in the urine. Melatonin is also readily absorbed orally but has a short half-life. It undergoes rapid metabolism in the liver, primarily via hydroxylation by CYP1A2, followed by conjugation with glucuronic acid, and is excreted in the urine.
- Mode of action: At the cellular level, DHEA’s influence on sex hormone production occurs via steroidogenic pathways in the ovaries. Melatonin’s action on the SCN involves modulation of neuronal activity, affecting circadian rhythm control. Its antioxidant properties involve scavenging free radicals and reducing oxidative stress.
- Receptor binding: DHEA interacts with androgen and estrogen receptors. Melatonin primarily binds to MT1 and MT2 receptors in the SCN.
Dosage
Standard Dosage
Adults:
- The typical dosage of DHEA is 25–75 mg daily. Melatonin dosage typically ranges from 1-3 mg, taken in the evening for sleep regulation. However, optimal dosage varies based on individual patient needs and the specific formulation. Slow-release formulations like MEM4 (20 mg DHEA / 3 mg melatonin) may offer benefits in terms of sustained hormone levels.
Children:
- This combination is generally not recommended for children.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary. Start with a low dose and titrate upwards based on response and tolerance.
- Patients with Renal Impairment: Caution is advised, and dose adjustment may be necessary.
- Patients with Hepatic Dysfunction: Dose modification is required due to DHEA and melatonin metabolism in the liver.
- Patients with Comorbid Conditions: Caution is warranted in patients with hormone-sensitive conditions (breast cancer, uterine cancer, endometriosis, PCOS), diabetes, cardiovascular disease, depression, and mood disorders.
Clinical Use Cases
- Dosage for specific clinical use cases like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations is not established for this combination.
Dosage Adjustments
- Dose modifications should be individualized based on patient-specific factors such as age, renal function, hepatic function, and concomitant medications.
Side Effects
Common Side Effects
- Nausea, stomach ache, fatigue, mood swings, headache, acne, hair loss, and insomnia.
Rare but Serious Side Effects
- Hepatotoxicity, cardiovascular events (e.g., palpitations), changes in blood pressure, and hormonal imbalances.
Long-Term Effects
- Potential long-term effects are not well-established but may include cardiovascular risks, mood disturbances, and changes in hormonal profiles.
Adverse Drug Reactions (ADR)
- Severe allergic reactions, mania, hepatotoxicity, and worsening of underlying mood disorders are potential ADRs.
Contraindications
- Hypersensitivity to DHEA or melatonin, hormone-sensitive cancers (breast, ovarian, prostate), endometriosis, uterine fibroids, PCOS, severe liver disease, uncontrolled diabetes, and bleeding disorders.
Drug Interactions
- DHEA may interact with anticoagulants (warfarin), antidepressants, antidiabetic medications, and hormone replacement therapy. Melatonin can interact with sedatives, anticoagulants, immunosuppressants, and medications metabolized by CYP1A2.
- Alcohol and grapefruit juice may interact with both DHEA and melatonin.
- Interactions may also occur with herbs that affect heart rhythm.
Pregnancy and Breastfeeding
- Not recommended during pregnancy or breastfeeding due to insufficient safety data. DHEA can have hormonal effects on the developing fetus. Melatonin may inhibit ovulation and has unknown effects on breastfeeding infants.
Drug Profile Summary
- Mechanism of Action: DHEA acts as a precursor to sex hormones, enhancing egg production. Melatonin regulates circadian rhythms and possesses antioxidant properties.
- Side Effects: Nausea, headache, fatigue, mood swings, acne, insomnia, and potential hepatotoxicity.
- Contraindications: Hormone-sensitive cancers, endometriosis, liver disease, and bleeding disorders.
- Drug Interactions: Anticoagulants, antidepressants, antidiabetics, sedatives, and CYP1A2 substrates.
- Pregnancy & Breastfeeding: Not recommended.
- Dosage: Adult: DHEA 25-75mg/day, Melatonin 1-3 mg/day. Varies based on formulation and individual needs.
- Monitoring Parameters: Hormone levels, liver function tests, blood pressure, and blood glucose.
Popular Combinations
- Coenzyme Q10 is often combined with DHEA and melatonin in some formulations intended to support fertility.
Precautions
- General Precautions: Pre-screening for allergies, hormonal imbalances, liver dysfunction, and relevant medical history.
- Specific Populations: Use with caution in patients with mood disorders, diabetes, and cardiovascular issues. Not recommended for children.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Dehydroepiandrosterone + Melatonin?
A: DHEA dosages range from 25-75 mg/day, while Melatonin is typically 1-3 mg/day. Optimal dosages vary based on patient needs and the specific product. Consult a healthcare provider for appropriate dosage recommendations.
Q2: What are the primary uses of this medication?
A: Primarily used for female infertility due to diminished ovarian reserve. Also potentially beneficial for improving sleep quality in some individuals.
Q3: Are there any significant drug interactions to be aware of?
A: Yes, potential interactions exist with anticoagulants, antidepressants, antidiabetics, and sedatives. Consult a physician about potential interactions with existing medications.
Q4: Can this combination be used during pregnancy or while breastfeeding?
A: No, this combination is generally not recommended during pregnancy and breastfeeding due to limited safety data.
Q5: What are the common side effects?
A: Common side effects can include nausea, headache, fatigue, mood swings, acne, and insomnia.
Q6: Are there any serious adverse reactions associated with this combination?
A: Rarely, serious side effects such as liver damage, cardiovascular effects, and hormonal imbalances can occur.
Q7: What precautions should be taken before starting this medication?
A: Patients should inform their doctor about any pre-existing conditions, especially hormonal imbalances, liver disease, or mood disorders.
Q8: How does melatonin contribute to this combination?
A: Melatonin’s antioxidant properties can protect ovarian follicles from oxidative damage and may contribute to improved fertility. It also helps with sleep regulation, which is important for overall health.
Q9: Are there any lifestyle considerations while taking this medication?
A: Patients should avoid alcohol and excessive caffeine intake while on this medication. Discuss any other supplements or herbal products with your doctor.
