RMeolton pharmaco and adverse effects

The drug is metabolized by hepatic cytochrome P450, forming an active metabolite. The P450 inducer rifampin markedly reduces plasma levels of ramelteon and its metabolite. Conversely, inhibitors of CYP1A2 (eg, fluvoxamine) or CYP2C9 (eg, fluconazole) increase plasma levels of ramelteon. The adverse effects of the drug include dizziness, fatigue, and endocrine changes including decreased testosterone and increased prolactin. Tasimelteon, a similar melatonin receptor agonist, has recently been approved.