Emerging treatments
Melatonin receptor agonists
Ramelteon, a highly selective melatonin receptor agonist with high affinity for melatonin MT1 and MT2 receptors, has been approved as a medication for insomnia. In one randomized controlled trial of ramelteon in 110 adults flying eastward across 5 time zones, ramelteon reduced the latency to persistent sleep by approximately 10 minutes compared to placebo but did not shift the circadian phase. However, individuals in the ramelteon group performed significantly worse on memory testing on the fourth day of treatment. Further studies on the sleep-promoting and phase-shifting effects of ramelteon are needed to fully understand the use of ramelteon as a treatment for jet lag disorder.[20] Tasimelteon was approved by the Food and Drug Administration (FDA) in 2014 and received a marketing authorization by the European Medicines Agency in 2015 for treatment of non-24-hour sleep-wake rhythm disorder in totally blind individuals. Use of melatonin receptor agonists for both the insomnia associated with jet lag and retraining the circadian rhythm requires further study.
Armodafinil
Armodafinil, the longer-lasting R-isomer of racemic modafinil, is a wakefulness-promoting medication. In a phase 3, double-blind, randomized, placebo-controlled trial, armodafinil increased wakefulness after eastbound travel through 6 time zones in those with a history of symptoms of jet lag, and was generally well tolerated.[21]
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