The NHS should not prescribe melatonin for jetlag because there is little evidence it relieves the symptoms of jetlag, according to an expert review published today.
The review, published in Drugs and Therapeutics Bulletin, is the same as it published in 1998, when it stated that while melatonin could lessen the severity and duration of jet lag, it would not recommend its use in the absence of stronger evidence and a product licence to guarantee its quality and safety.
David Phizackerley, review co-author and dtb deputy editor, said in a linked podcast that the licence issue has been resolved but there remain “lots of unanswered questions about [melatonin for jet lag]”.
Melatonin has been licensed for the treatment of jet lag within the European Union for the past 10 years, which meant the manufacturer was under no obligation to provide any new clinical data for UK approval.
The evidence on which the licensing decision was based dates back to 1986-2005 and includes 10 randomised controlled trials and four systematic reviews. However, this latest review points out that it often not clear what type of melatonin was used.
In the podcast, Dr James Cave, review co-author and dtb editor in chief, says while the studies showed melatonin lessened symptom severity, it did not get rid of them altogether. The studies did not assess possible side effects – for example, it is known that melatonin can increase seizure frequency in people who have epilepsy.
Dr Cave said there was no reason to change the stance dtb adopted in 1998. He also raised concerns that prescription melatonin may also start to be used for general insomnia.
“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 says in the podcast.
The review concludes: “Since jet lag is a self-limiting, short-term problem and there is limited published evidence of the benefit of melatonin on symptoms, we do not think that it is appropriate for such a product to be made available through the National Health Service.
“We would suggest that melatonin for jet lag is added to the list of drugs that may not be ordered under a General Medical Services Contract.”
Cave J, Phizackerley D. Melatonin for jet lag. Drug and therapeutics Bulletin. 14 January 2020; doi 10.1136/dtb.2019.000074
Leave a Reply