In rare cases, severe anaphylactic and anaphylactoid reactions have occurred following use of Ramelteon. Angioedema involving the tongue, glottis, or larynx has been reported. Some patients have had additional symptoms such as dyspnea, throat closing, or nausea and vomiting that suggest anaphylaxis. Reactions may require emergency treatment and may be fatal. Patients who develop such reactions should not be rechallenged. Ramelteon should not be used in patients with severe hepatic impairment or in combination with fluvoxamine. Failure of insomnia to remit after 7–10 days, worsening of insomnia, or emergence of new cognitive or behavioral abnormalities should be medically evaluated, as...
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