Melatonin is a significant ingredient in specials medicines. In the quarter to September 2018, melatonin was included in 28 per cent of special order items, and melatonin formulations accounted for 19 per cent of specials NIC.3

The most commonly prescribed specials presentation by far was melatonin oral solution 5mg/5ml, with 14,452 items prescribed at a NIC of £581,447. However, in June 2019 a market authorisation for melatonin 1mg/ml oral solution from Colonis Pharma was granted, so the impact of melatonin on specials may decline.

That said, at least 26 different formulations of melatonin in solid and liquid forms have been dispensed as specials. Products included tablets in four different strengths, capsules in nine different strengths plus modified release versions, solutions (five strengths), suspensions (five strengths), and a melatonin liquid.

Having a licensed product will not always remove the need for specials. Annual prescription cost analysis data for 2018 shows that the licensed product Circadin Tablets 2mg accounted for 81% of all melatonin items dispensed, and 43 per cent of that was as a class 2 item, meaning a treatment ordered generically but only available as a proprietary product.2

However, in the quarter to September 2018, while only 50 prescriptions for melatonin tablets 2mg were supplied as special order, there were 5,683 supplies of melatonin 2mg capsules, and a further 100 supplies of modified release capsule 2mg prescriptions supplied as specials.3