7 Ramelteon (Rozerem) Side Effects: What to Expect When Taking This Sleeping Pill

If you’re dealing with insomnia, ramelteon (Rozerem) is one medication to consider. It works similarly to the sleep supplement melatonin. But it has a few differences, such as lasting longer in the body.

Ramelteon is known among sleep medications for its mild side effects. In fact, people who took ramelteon in clinical trials reported side effects just about as often as those who didn’t take it. Regardless, it’s still helpful to know which side effects may be possible and what to do if they happen to you.

Ramelteon side effects at a glance

During clinical trials, only a small percentage of people reported side effects with ramelteon. These side effects were generally mild and usually didn’t result in people stopping the medication.

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Common ramelteon side effects include:

• Drowsiness

• Fatigue

• Dizziness

• Nausea

• Trouble sleeping

Less common but potentially serious ramelteon side effects include:

• Worsening depression, including suicidal thoughts

• Hallucinations

• Agitation and anxiety

• Complex sleep behaviors

• Allergic reactions

Below, we’ll review seven ramelteon side effects to know about when taking this medication.

1. Drowsiness

As you might expect from a sleep medication, taking ramelteon can cause you to feel drowsy, or sleepy. If you only feel drowsy at night, then this side effect shouldn’t be a problem.

Taking ramelteon as recommended, within 30 minutes of going to bed, can help you feel sleepy at the right time. Avoid taking your dose with or right after a high-fat meal, since this can affect how ramelteon is absorbed by the body and when it takes effect. 

If you take a ramelteon dose in the middle of the night, within a few hours of waking, or if you don’t plan for at least 7 hours of sleep, you may be sleepier than usual the next day. But even if you take ramelteon at the recommended time, next-day drowsiness is still possible. So it’s best to avoid tasks that require you to be alert, such as driving, until you know how ramelteon affects you.

If you’re often drowsy the morning after taking ramelteon, check with your healthcare team. They may suggest changing medications to avoid this issue.

2. Fatigue

Fatigue, or feeling tired or out of energy, is another possible ramelteon side effect. Keep in mind that you might also feel fatigued if you aren’t getting a good night’s rest due to insomnia. There are many more possible causes of fatigue as well.

You may be able to manage fatigue by eating a healthy diet, exercising regularly, and practicing good sleep hygiene. But if you experience bothersome or excessive fatigue after starting ramelteon, let your care team know and they can help determine the cause and next steps.

3. Dizziness

While taking ramelteon, you may also experience dizziness as a side effect. There are several potential causes of dizziness, so it may not always be related to your medication. And in many cases, dizziness might not pose a big problem since you’ll typically go to bed after taking ramelteon.

If you’re having dizziness throughout the day, take precautions to avoid falling. Also, avoid activities that can be more dangerous if you’re dizzy. Talk with your healthcare team if you have dizziness that becomes bothersome or isn’t going away.

4. Nausea

Feeling nauseous is a side effect of many medications, including ramelteon. However, keep in mind that insomnia can make you feel nauseated, too.

If you have nausea while taking ramelteon, there are a few things you can try. These include taking the medication with a small, low-fat snack, staying hydrated, and avoiding spicy or fried foods that can worsen nausea. If you still have an upset stomach, your healthcare team can look into what may be causing it.

5. Worsening insomnia

During clinical trials, some people reported that they got worse sleep while taking ramelteon. While ramelteon is intended to improve sleep, it can sometimes make your sleep more interrupted. This might lead to feeling more tired in the daytime.

If you think that your sleep has worsened after taking ramelteon, talk with your prescriber. They might ask about your sleep routine and environment, since these things can also affect how well you sleep. If ramelteon isn’t improving your sleep or is making it worse, they may suggest trying a different medication.

6. Changes in thinking and behavior

Sleep medications have been associated with various changes in thinking and behavior. This may also be possible with ramelteon. Symptoms can include worsened depression and thoughts of suicide, particularly in people with pre-existing depression. Hallucinations, agitation, and anxiety have also been reported.

Contact your prescriber right away if you notice any changes in your thinking, mood, or behaviors.

For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the 988 Suicide & Crisis Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line. 

7. Complex sleep behaviors

Sleep medications, including ramelteon, can also cause what are called “complex sleep behaviors.” These behaviors happen when you’re not fully awake, and sometimes you can’t remember that they happened. Examples include “sleep-driving,” preparing and eating food, and making phone calls while you’re partially asleep.

These behaviors might be inconvenient or strange, but they can also be dangerous. And they can be more likely if you drink alcohol or take other sedative medications, like opioids or benzodiazepines, with ramelteon. If you or someone else notices these behaviors, talk to your prescriber for next steps.

When should you contact your prescriber about ramelteon side effects?

As mentioned above, many ramelteon side effects are mild and can be handled at home. But don’t hesitate to reach out to your healthcare team if you have questions. They can give you specific recommendations to relieve your symptoms. And they may suggest a medication adjustment, if needed.

If you have symptoms of worsening depression, suicidal thoughts, or complex sleep behaviors, contact your healthcare team right away. If you feel your symptoms are life-threatening, call 911 or go to the nearest ER.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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