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Efficacy of Ramelteon on Insomnia Symptoms Associated With Jet Lag in Healthy Adult Volunteers

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00492011
Recruitment Status : Completed
First Posted : June 27, 2007
Last Update Posted : February 28, 2012
Information provided by (Responsible Party):

Brief Summary:
The purpose of this study to determine the degree to which ramelteon, once daily (QD), can reduce the insomnia symptoms associated with rapid, eastward travel across 5 time zones.

Condition or disease Intervention/treatment Phase
Circadian Dysregulation Drug: Ramelteon Drug: Placebo Phase 4

Detailed Description:

Circadian dysrhythmia, or jet lag, is defined as multiple biologic and psychologic stresses created by rapid travel across multiple time zones. As more people are transported by jet aircraft, the issue of jet lag becomes more important. What was an inconvenience during travel for leisure is now a physiologic consequence for the travelers and crew.

Jet lag is composed of a variety of unpleasant symptoms that vary with the number of time zones crossed, the individual, and even the direction flown (east versus west). The most typical symptoms include daytime sleepiness, fatigue, impaired alertness, and trouble initiating and maintaining sleep. Other symptoms of circadian dysrhythmia are insomnia, gastrointestinal complaints, apathy, weakness, irritability, malaise, and loss of appetite. Travel across time zones also has been associated with diabetic ketoacidosis, depression, and impaired cognitive performance in individuals at risk. Decreased sport performance has been noted in several studies.

In addition to environmental and social cues, physical factors, such as age, hydration status, and illness, could adversely affect the ability to entrain (adjust) quickly. The stressors of flight, noise, vibration, decreased humidity, barometric pressure changes, and decreased partial pressure of oxygen all contribute to crew and travelers health at the destination.

Being out of synchronicity with the environment causes jet lag symptoms. Travel through time zones places the body in a situation when it must sleep when not tired and awaken when the internal cues are initiating sleep. The brain's internal clock is the suprachiasmatic nucleus within the hypothalamus the body is in a constant state of circadian adjustment to remain entrained to a given time zone. In addition to the subjective feeling of well being are measurable changes associated with daily patterns. For example, core body temperature changes throughout the day and decreases before falling asleep. Melatonin levels increase in the evening and night and recede during the day.

Ramelteon is a melatonin receptor 1 and melatonin receptor 2 agonist currently marketed in the US for the treatment of insomnia characterized by difficulty with sleep onset. Study participation is anticipated to be about 2 weeks.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 110 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Randomized, Double-blind, Placebo-controlled, Parallel Group Study to Evaluate the Ability of Ramelteon 1 mg, 4 mg, and 8 mg to Alleviate the Insomnia Symptoms Associated With Eastward Bound Jet Lag Across 5 Time Zones in Healthy Adult Volunteers
Study Start Date : February 2007
Actual Primary Completion Date : August 2007
Actual Study Completion Date : August 2007

Resource links provided by the National Library of Medicine

Drug Information available for: Ramelteon

Arm Intervention/treatment
Experimental: Ramelteon 1 mg QD Drug: Ramelteon
Ramelteon 1 mg, tablets, orally, once nightly for 4 nights.
Other Names:
  • TAK-375
  • Rozerem™

Experimental: Ramelteon 4 mg QD Drug: Ramelteon
Ramelteon 4 mg, tablets, orally, once nightly for 4 nights.
Other Names:
  • TAK-375
  • Rozerem™

Experimental: Ramelteon 8 mg QD Drug: Ramelteon
Ramelteon 8 mg, tablets, orally, once nightly for 4 nights.
Other Names:
  • TAK-375
  • Rozerem™

Placebo Comparator: Placebo Drug: Placebo
Ramelteon placebo-matching tablets, orally, once nightly for 4 nights.

Primary Outcome Measures :
  1. Average Latency to Persistent Sleep measured by polysomnography. [ Time Frame: Nights 2, 3, and 4 ]

Secondary Outcome Measures :
  1. Dim light melatonin offset time in a subset of subjects defined as the time of the morning when the melatonin drops to below 3 pg/mL with a downward slope. [ Time Frame: Nights 2, 3, and 4 ]
  2. Total sleep time in minutes by polysomnography. [ Time Frame: Nights 2, 3, and 4 ]
  3. Number of awakenings after persistent sleep by polysomnography. [ Time Frame: Nights 2, 3, and 4 ]
  4. Wake time after persistent sleep onset by polysomnography. [ Time Frame: Nights 2, 3, and 4 ]
  5. Sleep efficiency by polysomnography. [ Time Frame: Nights 2, 3, and 4 ]
  6. Karolinska Sleepiness Scale [ Time Frame: Days 1, 2, 3, 4 and 5 ]
  7. Pittsburgh Sleep Quality Index [ Time Frame: Day 6 ]
  8. Daytime Function measured by Daytime Function Questionnaire (DTFQ) and Psychomotor Vigilance test (PVT) [ Time Frame: Day 3 ]
  9. Digit Symbol Substitution Test [ Time Frame: Days 1, 2, 3, 4 and 5 ]
  10. Memory Recall Test [ Time Frame: Days 1, 2, 3, 4 and 5 ]
  11. Visual Analogue Scale for Mood and Feelings, level of alertness and ability to concentrate [ Time Frame: Days 1, 2, 3, 4 and 5 ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 50 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria

  • Females of childbearing potential who are sexually active must agree to use adequate contraception, and can neither be pregnant nor lactating from Screening throughout the duration of the study.
  • Willing to travel from Hawaii to the East Coast and have a minimum stay of 6 days at the destination in a sleep laboratory during the entire study.
  • Has lived in Hawaii for at least 12 months and has not been traveling outside of Hawaii for 4 consecutive days within 30 days prior to the Outpatient Screening Visit.
  • History of sleep disturbance associated with jet lag symptoms, with at least two occurrences in the last three years, as defined in the International Classification of Sleep Disorders.
  • Habitual bedtime should be determined by sleep history as between 9:00 PM and 12:00 AM as determined by sleep history prior to randomization.
  • Have regular bedtime (within 1 hour) for 1 week prior to travel.
  • The subject has a subjective sleep latency of less than 30 minutes and a subjective total sleep time of 6.5 hours but less than 9 hours, as determined by sleep history.
  • Mean subjective sleep latency of less than 30 minutes and a mean subjective total sleep time of greater than 6.5 hours but less than 9 hours in 3 of 5 nights after the outpatient screening visit, as determined by post-sleep questionnaire.
  • Willingness and ability to comply with study procedures, including travel time, sleep, and waking-hour activities, light-exposure restriction, and food intake.
  • Body mass index between 18 and 34, inclusive.
  • Negative test result for selected substances of abuse (including alcohol) at Initial Screening, the In-Patient Actigraphy Screening Nights 1 and 2, and the Treatment Period.
  • Negative test result for hepatitis B Surface antigen and hepatitis C virus antibody.

Exclusion Criteria

  • Known hypersensitivity to ramelteon or related compounds, including melatonin, and melatonin related compounds.
  • History of primary sleep disorders as determined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Revised within the past 6 months.
  • Current sleep disorder as assessed by presence of sleep apnea, period leg movement syndrome, insomnia, daytime napping of more than 20 minutes, chronic fatigue.
  • Ever had a history of seizures, sleep apnea, restless leg syndrome, periodic limb movement syndrome, or chronic obstructive pulmonary disease.
  • History of psychiatric disorder (including schizophrenia, bipolar disorder, mental retardation, or cognitive disorder, anxiety, or depression) within the past 12 months.
  • Current, clinically significant neurological (including cognitive), hepatic, renal, endocrine, cardiovascular, gastrointestinal, pulmonary, hematological, or metabolic disease, as determined by the investigator.
  • History of alcohol abuse within the past 12 months, as defined in Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Revised, or regularly consumes more than 14 alcoholic drinks per week.
  • History of drug abuse within the past 12 months, as defined in Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Revised.
  • Positive urine drug screen or a positive urine drug screen or alcohol breathalyzer test.
  • Sleep schedule changes required by employment (eg, shift worker) within 3 months prior to the administration of single blind study medication.
  • Positive hepatitis panel including anti- hepatitis A virus (only IgM is exclusionary), hepatitis B surface antigen, or anti- hepatitis C virus.
  • Any clinically important abnormal finding as determined by a medical history, physical examination, electrocardiogram, or clinical laboratory tests, as determined by the investigator.
  • Any additional condition(s) that in the Investigator's opinion would:

    • affect sleep/wake function
    • prohibit the subject from completing the study
    • cause a situation such that it would not be in the best interest of the subject to participate in the study.
  • Participated in a weight loss program or has substantially altered their exercise routine within 30 days prior to the administration of study medication.
  • Smokes greater than 3 cigarettes per day or uses tobacco products during nightly awakenings.
  • Has flown across greater than 3 time zones within 28 days prior to or during screening.
  • Reports high caffeine consumption (greater than 600 mg daily).
  • Participated in any other investigational study and/or taken any investigational drug within 30 days or 5 half-lives of the investigational drug prior to the first dose of double blind study medication, whichever is longer.
  • Used any central nervous system medication within 1 week (or 5 half lives of the drug, whichever is longer) prior to the administration of study medication. These medications must not have been used to treat psychiatric disorders.
  • Used prescription or over-the-counter (OTC) hypnotic medication (including melatonin) within 3 months of the screening visits.
  • Is required to take or continues taking any disallowed medication, prescription medication, herbal treatment or over-the counter medication that may interfere with evaluation of the study medication, including:

    • Anxiolytics
    • Sedatives
    • Antidepressants
    • CNS active drugs (including herbal)
    • Anticonvulsants
    • Narcotic analgesics
    • Sedating H1 antihistamines
    • St. John's Wort
    • Systemic steroids
    • Kava-kava
    • Respiratory stimulants
    • Ginkgo-biloba
    • Decongestants
    • Over-the-counter and prescription stimulants
    • Antipsychotics
    • Over-the-counter and prescription diet aids
    • Muscle Relaxants Drugs affecting sleep/wake function
    • Melatonin
    • Modafinil

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00492011

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United States, Florida
Miami, Florida, United States
Pembroke Pines, Florida, United States
United States, Hawaii
Honolulu, Hawaii, United States
United States, New York
New York, New York, United States
Sponsors and Collaborators
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Study Director: Medical Director Clinical Science Takeda

Additional Information:
Publications of Results:
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Responsible Party: Takeda Identifier: NCT00492011     History of Changes
Other Study ID Numbers: 01-04-TL-375-045
U1111-1115-1566 ( Registry Identifier: WHO )
First Posted: June 27, 2007    Key Record Dates
Last Update Posted: February 28, 2012
Last Verified: February 2012

Keywords provided by Takeda:
Circadian Rhythm Disorders
Biological Clock Disturbances
Jet Lag Syndrome
Time Zone Change Syndrome
Drug Therapy

Additional relevant MeSH terms:
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Jet Lag Syndrome
Chronobiology Disorders
Nervous System Diseases
Sleep Disorders, Circadian Rhythm
Sleep Wake Disorders
Travel-Related Illness
Signs and Symptoms
Mental Disorders