5-hydroxytryptophan/melatonin/pyridoxine Disease Interactions

A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of most anxiolytics, sedatives and hypnotics. Some of these changes include decreased inhibition, aggressiveness, agitation, and hallucinations. These drugs can cause or exacerbate mental depression and cause suicidal behavior and ideation. Therapy with these drugs should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

In general, anxiolytics, sedatives and hypnotics are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with these drugs should be administered cautiously in patients with liver disease (some are not recommended in severe liver impairment), and the dosage should be adjusted accordingly. Laboratory testing is recommended prior and during treatment.

The B vitamins are readily absorbed in the GI tract following oral administration. However, GI absorption may be decreased in patients with malabsorption syndromes and other conditions. For example, the absorption of thiamine and pyridoxine may commonly be decreased in alcoholics and in patients with cirrhosis. Likewise, riboflavin absorption may be impaired in patients with hepatitis, cirrhosis, or biliary obstruction. When malabsorption of these vitamins is suspected, parenteral administration may be appropriate.