NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Melatonin Shared Care Update

The Shared Care Protocol for melatonin for use in children with sleep disturbance has been reviewed, with new products added and a change to how it will be prescribed in the community. The products listed are Bio-melatonin 3mg tablets, Circadin 2mg SR tablets and melatonin 1mg/ml liquid (available as a ‘special’).  The solid dose formulations are the preferred option and are suitable for the majority of patients. More details of the licensing status of these medicines can be found in the shared care protocol

 

These products allow a variety of doses to be prescribed and can be used in combination to achieve the total daily dose. It is not uncommon to find immediate and sustained release formulations co-prescribed as the combination addresses issues with sleep onset and sleep latency. The Bio-melatonin tablets can also be crushed and sprinkled on foodstuff where required.

 

Secondary care specialists, eg consultant psychiatrists and community paediatricians will initiate melatonin therapy using HBP prescription pads (“blue pads”) until the patient is stabilised on a maintenance dose (usual range 3-9mg daily). After this, with agreement, the GP will prescribe. Each CAMHS or child health community base will have access to HBPs for melatonin prescribing. These should not be used for regular out-patient prescribing.  Usage of the pads will be monitored and reviewed on a regular basis. Supply of BioMelatonin and the 1mg/ml liquid in the hospital setting requires an unlicensed medicine (ULM) form to be completed including a consultant signature. 

 

This new arrangement for melatonin prescribing in the community is expected to start in October 2016, however existing prescribing arrangements will continue until the new arrangements for HBP pads are fully in place. Use of melatonin in adults remains non-Formulary.

 

Please note that after discussion with the Local Medical Committee, shared care protocols are now to be called shared care agreements and the terminology will be updated as each reaches its review date. All information on the shared care agreements can be found on our website.

 

 

Published 31/08/2016