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Melatonin as a probable cause of diarrhoea.

A 49 year old woman presented with diarrhoea lasting for 3 weeks with 3-4 liquid bowel movements per day, with abundant bowel sounds. She had no pathologic findings in her stools, abdominal pain, rectal tenesmus or fever. There was some weight loss (2 kg) but no lack of appetite or nocturnal episodes. Her primary care physician had prescribed loperamide 1 mg every 8 hours to control the diarrhoea. The patient indicated that the onset of symptoms began after taking an herbal product for insomnia, and that she was not using other drugs. Tests, which were carried out, included blood count, liver and renal function profile, thyroid stimulating hormone, vitamin B 12 , folate, erythrocyte sedimentation rate, C-reactive protein, immunoglobulin A, anti-endomysial and tissue transglutaminase IgA, stool culture, parasites in stool, and lactose intolerance. All test results were normal and therefore the focus was placed on investigating the composition of the product used for insomnia, which was melatonin 5 mg, taken daily. The onset of diarrhoea seems to have coincided with the use of melatonin and therefore the patient was advised to stop taking it. Symptoms disappeared completely. When the patient herself decided to restart taking the same dose of melatonin the clinical symptoms reappeared. Subsequently she reduced her melatonin intake to 1.8 mg per day, which controlled the insomnia with no side effects.