Palliative Pharmacotherapy/Miscellaneous/Helpful Dot Phrases

Melatonin
General melatonin info
 * MELATONIN is a naturally occurring hormone, produced by the pineal gland during the nocturnal phase of the circadian cycle and only during relative darkness. Older adults produce less MELATONIN than younger adults/children, and thus age-related insomnia may be contributing to pt's difficulty sleeping. MELATONIN should be administered before the natural increase in endogenous MELATONIN (which occurs ~10PM - 12AM). MELATONIN causes significantly more sleepiness when taking at 8pm vs 11pm, theoretically because the brain's receptors may be already saturated with endogenous MELATONIN late at night. Additionally, low levels of MELATONIN and/or lack of MELATONIN rhythmicity are associated with delirium. MELATONIN has minimal adverse effects and drug interactions.

Migraines
Promethazine as a migraine abortive
 * Promethazine may have more action than as an anti-emetic alone and could help abort migraines. (Reference: J Emerg Med. 2008 Oct;35(3):247-53) Further, a recent study identified that using promethazine with sumatriptan was better than using sumatriptan alone for migraine. (Reference: Headache. 2014 Jan;54(1):94-108.) Consider 12.5 or 25mg PR q4h with NOW dose to ensure effectiveness. If effective pt can be discharged with q4h PRN promethazine suppositories to help break future migraines.