P15 Melatonin prescribing audit
Authors: Wong See Mun 
Published: January 2018

Aim

To investigate the practice of melatonin prescribing amongst clinicians in outpatient setting and whether the treatment has been reviewed regularly.

Method

Data was collected from JAC (Pharmacy Computer System) report detailing patients receiving melatonin from pharmacy, cost centre, quantity, date between 1 st Nov 2014 and Oct 2015. Data on in-patient supply were excluded as the focus of the audit was around patients who are on long term treatment and are seen in outpatient clinics or in the community setting.

A sample of patients was randomly selected from the list. Details about consultant, clinical indication, whether melatonin was reviewed, date of clinic, other sedatives patients received, type of melatonin prescribed, were recorded by reviewing clinic letters between Nov 2014 and Dec 2015.

Results

A total of 774 patients received melatonin dispensed from pharmacy on 4 or more occasions between Nov 2014 and Oct 2015. In-patient supplies were excluded. 404 out of 774 patients were audited. The sample size was large enough to represent our overall population.

8% of patients were prescribed Circadin 2 mg tablets; 61% of patients were on a combination of unlicensed immediate release (IR) melatonin 2 mg capsules and Circadin; 31% of patients were on unlicensed IR melatonin 2 mg capsules.

238 (59%) patients attended follow up clinics and had their melatonin reviewed; 81 (20%) patients attended clinics but melatonin review was not documented; 42 (10%) patients who were on long term melatonin had not attended a clinic appointment for over a year and another 39 (10%) patients who were newly initiated on melatonin had not attended a follow up appointment since treatment started; 1% of patients were not due a clinic review since starting. Out of those who didn’t have their melatonin reviewed for over a year or since treatment had started, 52 (64%) patients failed to attend their clinic appointments.

26 (6.4%) patients were recorded to be on other sedatives concurrently in their clinic letters – 23 patients on chloral hydrate and 3 patients on promethazine.

6 (1.5%) patients were advised to either stop melatonin or take a holiday break, but out of these, 3 patients continued to receive melatonin supply from the pharmacy.

About 35% of patients have been on melatonin for 1 to 2 years and another 34% for 3 to 5 years. The longest treatment duration was over 9 years (17 patients).

Conclusion

Melatonin is prescribed across many different specialties both within the hospital and in the community with the greatest proportion being prescribed for sleep disorders in Attention Deficit Hyperactivity Disorder. There was a general lack of clinic review regarding efficacy, doses and duration of treatment. In over 60% of cases this was due to patients failing to attend clinic appointments. It is questionable why melatonin is continued to be prescribed without regular treatment review. The concurrent use of other sedatives in some patients is debatable. This information has been presented to prescribers. Another audit is planned in the end of 2016 to determine whether review of treatment has improved and will include an evaluation of melatonin efficacy.