{"id":1466,"date":"2021-11-29T21:23:13","date_gmt":"2021-11-29T20:23:13","guid":{"rendered":"https:\/\/sfrms-app.fr\/?p=1466"},"modified":"2022-11-06T16:57:41","modified_gmt":"2022-11-06T15:57:41","slug":"melatonine","status":"publish","type":"post","link":"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/29\/melatonine\/","title":{"rendered":"M\u00e9latonine"},"content":{"rendered":"<h2><span style=\"font-size: 14pt;\">Mode d&rsquo;action<\/span><\/h2>\n<ul>\n<li>La m&eacute;latonine ou N-ac&eacute;tyl-5-m&eacute;thoxytryptamine agit sur les r&eacute;cepteurs &agrave; m&eacute;latonine du NSC, du VLPO, et de nombreux organes p&eacute;riph&eacute;riques (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/12\/14\/physiologie-de-leveil-et-de-lendormissement\/\"><strong>Syst&egrave;me Flip-Flop<\/strong><\/a>).<\/li>\n<li>La m&eacute;latonine exog&egrave;ne pr&eacute;sente deux actions principales :\n<ul>\n<li><strong>Une action &laquo; <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/chronobiotique\/\" title=\"Glossary: Chronobiotique\" class=\"glossaryLink\">chronobiotique<\/a> &raquo;<\/strong> d&egrave;s l&rsquo;administration de faibles doses (&agrave; partir de 0,125 mg), permettant de synchroniser, avancer ou retarder le <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/rythme-circadien\/\" title=\"Glossary: Rythme circadien\" class=\"glossaryLink\">rythme circadien<\/a> (horloge biologique endog&egrave;ne) au <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/rythme-nycthemeral\/\" title=\"Glossary: Rythme nycth&eacute;m&eacute;ral\" class=\"glossaryLink\">rythme nycth&eacute;m&eacute;ral<\/a> (rythme veille-<a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/sommeil\/\" title=\"Glossary: Sommeil\"  class=\"glossaryLink\">sommeil<\/a> requis par l&rsquo;environnement). L&rsquo;effet chronobiotique pr&eacute;sente une <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/pharmacodynamie\/\" title=\"Glossary: Pharmacodynamie\" class=\"glossaryLink\">pharmacodynamie<\/a> non dose d&eacute;pendante, mais <strong>d&eacute;pendant du moment d&rsquo;administration par rapport &agrave; la <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/phase-circadienne\/\" title=\"Glossary: Phase circadienne\" class=\"glossaryLink\">phase circadienne<\/a>&#8239;<\/strong>; on parle de <strong><a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/courbe-de-reponse-de-phase\/\" title=\"Glossary: Courbe de r&eacute;ponse de phase\" class=\"glossaryLink\">courbe de r&eacute;ponse de phase<\/a> de la m&eacute;latonine<\/strong>.<\/li>\n<li><strong>Une action &laquo; soporifique &raquo;<\/strong> pour des doses plus &eacute;lev&eacute;es que l&rsquo;action chronobiotique (&agrave; partir de 2 mg) facilitant l&rsquo;<a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/endormissement\/\" title=\"Glossary: Endormissement\" class=\"glossaryLink\">endormissement<\/a>. L&rsquo;effet soporifique pr&eacute;sente une pharmacodynamie en relation dose-effet, c&rsquo;est-&agrave;-dire qui augmente avec la dose. L&rsquo;augmentation de dose s&rsquo;accompagne d&rsquo;une augmentation de l&rsquo;effet soporifique mais a priori avec des effets chronobiotiques similaires.<\/li>\n<\/ul>\n<\/li>\n<li>Il existe deux formes :\n<ul>\n<li>Action lib&eacute;ration imm&eacute;diate (LI): pr&eacute;paration magistrale, non rembours&eacute;e.<\/li>\n<li>Action lib&eacute;ration prolong&eacute;e (LP): CIRCADIN&reg;, non rembours&eacute;e.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2><span style=\"font-size: 14pt;\">Indications<\/span><\/h2>\n<ul>\n<li><strong><a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/syndrome\/\" title=\"Glossary: Syndrome\"  class=\"glossaryLink\">Syndrome<\/a> de <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/retard-de-phase\/\" title=\"Glossary: Retard de phase\" class=\"glossaryLink\">retard de phase<\/a> et <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/syndrome\/\" title=\"Glossary: Syndrome\"  class=\"glossaryLink\">syndrome<\/a> du d&eacute;calage horaire vers l&rsquo;est<\/strong> (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/12\/27\/troubles-du-rythme-cicardien-veille-sommeil\/\"><strong>Troubles du rythme circadien<\/strong><\/a>).<\/li>\n<li>Trouble insomnie chronique (CIRCADIN&reg; rembours&eacute; chez le sujet &gt; 55 ans) (cf. Fiches : <strong><a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/28\/les-hypnotiques\/\">Hypnotiques<\/a> &amp; <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/12\/27\/trouble-insomnie-chronique\/\">Trouble insomnie<\/a><\/strong>).<\/li>\n<\/ul>\n<h2><span style=\"font-size: 14pt;\">Contre-indications<\/span><\/h2>\n<p>Pas de contre-indication.<\/p>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"457\" height=\"332\" src=\"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/Capture-50.png\" alt=\"\" class=\"wp-image-1469\" srcset=\"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/Capture-50.png 457w, https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/Capture-50-300x218.png 300w\" sizes=\"auto, (max-width: 457px) 100vw, 457px\"\/><\/figure>\n<\/div>\n\n\n<h2 class=\"wp-block-heading\">Bilan pr&eacute; th&eacute;rapeutique<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">&Eacute;valuer la phase circadienne par :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&Eacute;valuation du <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/chronotype\/\" title=\"Glossary: Chronotype\"  class=\"glossaryLink\">chronotype<\/a> (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/28\/echelle-de-vesperalite-et-de-matinalite-de-horne-et-horsberg\/\"><strong>&Eacute;chelle vesp&eacute;ralit&eacute; et de matinalit&eacute; de Horne et Horsberg<\/strong><\/a>).<\/li>\n\n\n\n<li><a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/agenda-du-sommeil\/\" title=\"Glossary: Agenda du sommeil\" class=\"glossaryLink\">Agenda du sommeil<\/a> ou actim&eacute;trie (cf. Fiches : <strong><a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/27\/agenda-du-sommeil\/\">Agenda du sommeil<\/a> &amp; <a href=\"https:\/\/sfrms-app.fr\/index.php\/actimetrie\/\">Actim&eacute;trie<\/a><\/strong>).<br>La mesure du <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/dlmo\/\" title=\"Glossary: DLMO\"  class=\"glossaryLink\">DLMO<\/a> et du <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/minimum-thermique\/\" title=\"Glossary: Minimum thermique\" class=\"glossaryLink\">minimum thermique<\/a> peut &ecirc;tre utile en cas de situation clinique complexe, mais reste difficile &agrave; r&eacute;aliser.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">R&egrave;gles de prescription<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ordonnance classique.<\/li>\n\n\n\n<li>Si m&eacute;latonine LI : D&eacute;terminer le dosage et indiquer &laquo; pr&eacute;paration magistrale en dehors de sp&eacute;cialit&eacute; disponible &raquo;.<\/li>\n\n\n\n<li>Le moment de la prise est &agrave; d&eacute;terminer scrupuleusement en <strong>fonction de la phase circadienne suppos&eacute;e du patient<\/strong>, en tenant compte de la <strong>courbe de r&eacute;ponse de phase<\/strong> de la m&eacute;latonine.<\/li>\n\n\n\n<li><strong>Dans le cadre du syndrome de retard de phase (et du syndrome du d&eacute;calage horaire vers l&rsquo;est)<\/strong>\n<ul class=\"wp-block-list\">\n<li>Effet chronobiotique principalement recherch&eacute; (&lt; 2 mg),<\/li>\n\n\n\n<li>Heure de prise le soir <strong>1 h &agrave; 3 h avant l&rsquo;heure<\/strong> habituelle d&rsquo;endormissement,<\/li>\n\n\n\n<li>pour avancer la phase circadienne de sommeil (avance de la s&eacute;cr&eacute;tion de m&eacute;latonine).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>La lumi&egrave;re supprime la s&eacute;cr&eacute;tion de la m&eacute;latonine. Le moment de l&rsquo;exposition est donc aux horaires oppos&eacute;s &agrave; celle de la prise de m&eacute;latonine si ces traitements sont associ&eacute;s (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/29\/luminotherapie\/\"><strong>Luminoth&eacute;rapie<\/strong><\/a>).<\/li>\n\n\n\n<li>Dans le cadre du trouble insomnie :\n<ul class=\"wp-block-list\">\n<li>Efficacit&eacute; clinique faible, pr&eacute;f&eacute;rer TCC de l&rsquo;insomnie. Cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/28\/therapie-cognitive-et-comportementale-de-linsomnie\/\"><strong>TCC de l&rsquo;insomnie<\/strong><\/a>.<\/li>\n\n\n\n<li>Effet soporifique principalement recherch&eacute; (entre 2 et 6 mg maximum).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Surveillance des effets ind&eacute;sirables<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Rares effets secondaires.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Suivi d&rsquo;efficacit&eacute;<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Efficacit&eacute; clinique\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/avance-de-phase\/\" title=\"Glossary: Avance de phase\" class=\"glossaryLink\">Avance de phase<\/a> de sommeil (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/27\/agenda-du-sommeil\/\"><strong>Agenda du sommeil<\/strong><\/a>).<\/li>\n\n\n\n<li>Am&eacute;lioration de la plainte d&rsquo;insomnie (cf. Fiches : <strong><a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/27\/echelle-de-severite-de-linsomnie\/\">&Eacute;chelle de s&eacute;v&eacute;rit&eacute; de l&rsquo;insomnie<\/a> &amp; <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/27\/agenda-du-sommeil\/\">Agenda du sommeil<\/a><\/strong>),<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Efficacit&eacute; paraclinique : si n&eacute;cessaire, actim&eacute;trie (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/actimetrie\/\"><strong>Actim&eacute;trie<\/strong><\/a>).<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Mode d&rsquo;action La m&eacute;latonine ou N-ac&eacute;tyl-5-m&eacute;thoxytryptamine agit sur les r&eacute;cepteurs &agrave; m&eacute;latonine du NSC, du VLPO, et de nombreux organes p&eacute;riph&eacute;riques (cf. Fiche : Syst&egrave;me Flip-Flop). La m&eacute;latonine exog&egrave;ne pr&eacute;sente deux actions principales : Une action &laquo; chronobiotique &raquo; d&egrave;s [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":4061,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12,31],"tags":[],"class_list":["post-1466","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-traitement","category-traitements-des-troubles-du-rythme-circadien-veille-sommeil"],"featured_image_src":"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/UTwTq5an_normal.png","blog_images":{"medium":"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/UTwTq5an_normal.png","large":"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/UTwTq5an_normal.png"},"_links":{"self":[{"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/posts\/1466","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/comments?post=1466"}],"version-history":[{"count":9,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/posts\/1466\/revisions"}],"predecessor-version":[{"id":4771,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/posts\/1466\/revisions\/4771"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/media\/4061"}],"wp:attachment":[{"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/media?parent=1466"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/categories?post=1466"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/tags?post=1466"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}