Melatonin 'Unsuitable' for Jet Lag Treatment on the NHS

Peter Russell

January 14, 2020

Melatonin should not be prescribed on the NHS for treating jet lag, according to a review of available evidence.

Its use for the indication should be added to the list of drugs that may not be ordered under a General Medical Services Contract, the expert review in Drug and Therapeutics Bulletin (DTB) concluded.

Limited Available Evidence

Several clinical trials have assessed the effect of melatonin on symptoms of jet lag. However, many of the trials were small, most were published between 1986 and 2005, and details of the source or pharmaceutical form of melatonin were not always made available.

A Cochrane review , published in 2002, initially examined 10 trials comparing melatonin with placebo for treatment of jet lag.

However, Dr James Cave, DTB editor-in-chief, who co-authored the review, explained in a linked podcast: "They were actually only able to use four studies to actually give ourselves some combination of the data, and that amounted to 142 participants in total. So, you can see the weight of evidence here is not great."

A 2015 meta-analysis of the same four studies combined data on the severity of jet lag for eastward and westward flights. On a severity scale of 0 to 100, reported severity with melatonin was 27 compared with 45 for placebo, a mean difference of 17.7.

A previous review of melatonin by DTB in 1998 raised concerns about the absence of a product licence to ensure its quality and safety. However, this has since been addressed with a licensed form of melatonin (Colonis Pharma Limited) for the short-term treatment of jet lag in adults.

A 'Modest Effect' for Jet Lag

The latest expert review concluded that "melatonin appeared to have a modest effect on symptoms of jet lag compared with placebo".

It also noted adverse effects associated with melatonin treatment, including headache, nausea, drowsiness, and sedation.

Furthermore, melatonin could increase seizure frequency in people with epilepsy, and was not recommended for people with autoimmune diseases, severe renal impairment, or moderate or severe hepatic impairment.

While the licence issue has been resolved, there were still "lots of unanswered questions" about the use of melatonin for jet lag, said David Phizackerley DTB deputy editor and review co-author, in the podcast.

Prescription Only or Over-the-counter?

Melatonin is a prescription-only medicine in the UK, unlike other countries, including the US.

In the US, where melatonin is available over-the-counter, its use has increased. A 2017 study in the Journal of Clinical Sleep Medicine reported that over-the-counter demand had more than doubled in the US between 2007 and 2012. In 2012, an estimated 3.1 million Americans were taking melatonin.

Dr Cave said he saw no reason for the NHS to change its stance since the last review. "I have concerns also perhaps that you will get licence creep, and that it will be used for people with sleep problems in general, and it’s not really a good way of dealing with those," he said in the podcast.

DTB drug review. Melatonin for jet lag. DOI:10.1136/dtb.2019.000074

Editor's Note: This article was updated to clarify the drug's status outside the UK.

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