Which of the following is NOT an adverse effect of ramelteon?

Ramelteon is primarily used as a sleep aid, specifically for insomnia characterized by difficulties with sleep onset. Its mechanism of action involves the selective agonism of melatonergic receptors (MT1 and MT2) in the brain, promoting the sleep-wake cycle without the sedative properties typical of many other sleep medications.

Among the adverse effects associated with ramelteon, drowsiness, fatigue, and even, though less commonly, suicidal ideation have been reported. Drowsiness occurs as a direct result of its sleep-inducing properties, while fatigue can be a consequence of sleep alterations. Suicidal ideation is a potential risk with many CNS-active medications, particularly in vulnerable populations, although it is rarer with ramelteon compared to other sedative-hypnotics.

In contrast, weight gain is not commonly associated with ramelteon use. Unlike some other sleep medications that can lead to weight gain due to increased appetite or metabolic effects, ramelteon’s specific action on melatonin receptors does not typically induce these side effects. Therefore, recognizing that weight gain is not an established adverse effect of ramelteon helps clarify why this answer is correct.