• First line: melatonin 1mg and 5mg modified release tablets in line with licensed indications only.
• Second line: melatonin 1mg, 2mg, 3mg, 4mg and 5mg tablets (crushed if necessary).
• Third line: melatonin 1mg/1ml oral solution - 1st choice for patients unable to tolerate solid dose formulations. Consilient Health formulation to be used as it is alcohol and propylene glycol free

Approved Indications

Melatonin can be used to facilitate the induction of sleep, and increase the duration of sleep on the advice of an appropriate secondary care specialist, in the following situations:

1) Visually impaired or blind people with disturbed sleep wake cycles. 
2) Delayed sleep phase syndrome and other circadian rhythm disorders.
3) Children with neurological or behavioural disorders including: 

• Attention deficit hyperactivity disorder (ADHD).*
• Chronic sleep onset insomnia.*
• Neurodevelopmental disabilities (e.g. involving delayed brain maturation, sensory dysfunction - especially visual and dysfunction of sleep centres).*

4) Treatment of children and young adults with chronic fatigue syndrome / myalgic encephalomyelitis who have sleep difficulties (as recommended in NICE clinical guideline no. 53).* 
5) Prior to examinations such as a sleep encephalogram (EEG) in children and sedation prior to scans in paediatric oncology. 
6) Patients with injurious parasomnia including REM sleep behaviour disorder (RBD) – e.g associated with degenerative conditions such as Parkinson’s disease or dementia, as an alternative to clonazepam.
7) To improve nocturnal sleep in critically ill patients (to aid weaning from mechanical ventilation) 

*Note that for indications 3 and 4 in children and young people melatonin is classified as an ‘amber’ drug and therefore subject to formal shared care guidance.  Please follow relevant link below for the most recent guideline.