Melatonin should not be available on the NHS to treat the time lag | Society

The hormone melatonin should not be available on the NHS to help treat the time lag, a review of the evidence concluded.

Melatonin is a hormone produced in the body during darkness that plays a role in the body clock and helps regulate sleep cycles.

It is available in the NHS as a treatment for some sleep problems, even in older people and children with attention deficit / hyperactivity disorder (ADHD).

If it helps with the time lag it is less clear. However, in 2019, the UK Regulatory Agency for Medicines and Health Products authorized two melatonin products as a prescription drug to control jet lag in the short term.

Now, an independent review of drugs for the hormone by the Drug and Therapeutics Bulletin, a publication that summarizes and evaluates the evidence for medications and treatments, has concluded that the hormone should not be prescribed for the time lag in the NHS.

“We suggest that melatonin for the time lag be added to the list of medications that cannot be ordered under a General Medical Services Contract,” the authors wrote.

The authors analyzed the same collection of 14 studies (including 10 randomized placebo-controlled trials) that were submitted to the MHRC, as well as Cochrane reviews, the gold standard for observing evidence, and other studies of previous research on melatonin for Jet delay or to improve sleep.

Most clinical trials on melatonin for time lag, according to the team, were published between 1986 and 2005, and many were small. But since the hormone has been authorized for this purpose for more than 10 years in other parts of the EU, the MHRC did not require more modern data.

The team concluded that the evidence suggests that melatonin has a modest effect in reducing the symptoms of time lag: an analysis based on four previously published studies with a total of 232 participants suggested that those who received melatonin rated their jet delay like 27 on a 100 point scale. compared to 45 for those who received a placebo.

It also seems generally safe, although it can have side effects such as nausea and dizziness. It can also increase the seizure rate in people with epilepsy and cause problems for people with autoimmune diseases, and is not recommended during pregnancy or breastfeeding.

The team said 30 melatonin tablets of 3 mg each cost £ 65, while 150 ml of a 1 mg / ml solution costs £ 130.

However, the authors said that the evidence base for using the hormone for jet lag remains poor, and in any case the jet lag disappears on its own in a few days, and is not an important priority for the NHS.

“The question is, should NHS resources be used to support a short-term self-limited condition that is usually associated with pleasure and vacation travel?” Said David Phizackerley, deputy editor of the Drug and Therapeutics Bulletin.

Phizackerley said the team’s recommendation does not change the fact that doctors can currently prescribe melatonin for the time lag, although a summary of clinical knowledge for the National Institute of Excellence in Health and Care does not recommend melatonin for this purpose. But, he said, the review could help shape the guide if Nice decides to issue it.

Phizackerley said the review was not a criticism of the MHRA. “We are not questioning whether I should have a license, because it shows that it does something and seems to be relatively safe,” he said.

He added that restricting melatonin prescriptions so that it is not available for the time lag would avoid a zip code lottery. “It would be much easier for patients, because everyone would know that it is not available [on the NHS],” he said.

Dr. Neil Stanley, an independent sleep expert and author of How to Sleep Well, said that although there is some evidence that shows that melatonin is beneficial for time lag, studies vary widely in the dose that seems to have an effect, while the correct timing of the doses is complex. Large-scale studies, he added, would be costly to carry out with little profit in return.

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