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For the Attention of:  General Practitioners; Non-Medical Prescribers; Community Pharmacists; Primary Care Pharmacists; Hospital Clinicians; Hospital Pharmacists; Community Paediatrics; Acute Paediatrics; CAMHS; Service Managers for Community Paediatrics, Acute Paediatrics, CAMHS

NHS Fife Formulary Appendix 4I - Melatonin Guidance for the Treatment of Sleep-Wake Cycle Disorders in Children has been developed to provide advice and guidance on the use of melatonin in children with sleep-wake cycle disorders. The guidance has been approved for use in NHS Fife by the Fife Area Drugs & Therapeutics Committee (ADTC).

 The guidance covers the following areas –

  • Steps to consider prior to initiation of melatonin e.g. lifestyle changes, changes to stimulant medication, behavioural interventions.
  • When and how to prescribe melatonin. Fife Formulary choice is now melatonin M/R 2mg tablets (Circadin®). Circadin® is the only licensed formulation of melatonin in the UK. Circadin® is a modified –release tablet but it can be halved and still retain its slow-release profile. Circadin® tablets can also be crushed and dissolved in water for an immediate-release profile. All new patients initiated on melatonin should be prescribed Circadin®. Patients on alternative formulations e.g. Bio-melatonin 3mg tablets, melatonin capsules, melatonin liquid should be switched to Circadin® if clinically appropriate when the patient is next reviewed.
  • The guidance also provides advice on the roles and responsibilities of the Specialist, GP and patient/carer.
  • Appendix 1 of the guidance provides information for the patient/carer on crushing Circadin® tablets.

Principal Pharmacist - Clinical Effectiveness/ Professional Secretary NHS Fife ADTC