Increased evidence implies that melatonin may be a promising molecule for combating COVID-19 due to its potent antioxidative, anti-inflammatory and immunoregulatory capacities. A frequently asked question concerns the suitable dosage of melatonin for deadly virus infections including COVID-19 patients. The golden standards for a suitable dosage of medicine are safety and effectiveness. By reviewing the pharmacokinetics as well as animal studies and clinical trials of melatonin in the deadly viral infections and sepsis, we estimate that a dose of 8 mg/kg/day of melatonin is suitable for COVID-19 patients, especially for the severe cases. To maintain an elevated melatonin serum level lasting longer and smoother, this daily dose can be divided into 5 sub-doses with the initial dose of doubling over the other sub-doses. The recommended dose is in the ranges used to treat septic patients clinically and is devoid of any adverse effect; thus, it is safe. This dose is calculated from an effective dose which significantly reduces the mortality of virus-infected mice and is, therefore, assumed to be effective for COVID-19 severe patients. In our opinion, a dose or a medicine which can only improve the symptoms of mild or moderately severe patients of COVID-19 lack biological significance since virus infection is a self-limited disease and most of the patients with mild or moderate symptoms will recover by themselves whether treated or not. A meaningful treatment is to target the severe patients and significantly reduce the resulting mortality. The suggested melatonin dose is, thus, mainly recommended for the severe COVID-19 patients. The possibility of using suppositories for the delivery of highly dosed melatonin is also addressed, since long-term experience with this treatment is available for another disease.
Renal Biopsy Findings in Children Receiving Long-Term Treatment with Cyclosporine A Given as a Single Daily Dose
