G145(P) Melatonin – Audit of prescribing practice for children in a rural population

Introduction Melatonin is indicated for treatment of sleep problems in children with neuro-developmental disorder. No national guidelines exist but most NHS organisations have local evidence based guidelines. Due to wide geographical distribution of our rural population, melatonin is prescribed on FP10 forms from the community services. The cost varies widely depending on the individual pharmacy charge, formulation and the brand dispensed. This audit was undertaken to establish the current use of melatonin in our children. Methods Data was collected from pharmacies across the geographic area on all children between 0–16 years on melatonin prescription during the month of August 2012. Clinic letters were reviewed via hospital shared drive to collect further information. Results A total of 106 children were on melatonin during the month of August 2012. Hospital records of 99 children were examined. 81% were boys. The median age was 11 years. 98% of children had significant neuro-disability with predominant diagnosis of ADHD (58.5%), autism (25%), learning difficulties (14%), oppositional defiant disorder (14%), epilepsy (12%) and other neuro-disability (12%). Starting dose was between 2–4 mg. 72% were on maintenance dose between 2–6 mg. Information was not available on exact formulation used but almost all were on standard acting preparation. Duration of use was variable ranging from less than 6 months (4.1%), 6–12 months (25%), 1–2yr (28%), 2–3yr (28%),3–4yrs (5.5%), 4–5 yrs (5.5%) and more than 5 years (4.1%). Efficacy as recorded in clinic letters was considered satisfactory in 44%, some benefit in 17.4% and unsatisfactory in 10% of children. No significant side effects were recorded.45% of children had behavioural interventions.25% children were under specialist CAMHS services. Conclusion Melatonin was used appropriately in all children and was considered effective in 60% of children. There was general lack of clinical review regarding doses and duration of treatment and paucity of data on the exact formulation and brand used. Behavioural interventions were underutilised. Centralising and standardising the prescription process through the NHS hospital based pharmacy would reduce the cost but would cause difficulties in accessing the service in view of wide geographic distribution and travel time.