Content area
Full Text
Correspondence to Julia Kuczynska, South West Medicines Information and Training, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Bristol BS2 8HW, UK; [email protected]
Introduction
A 6½-year-old boy—weight 28 kg and height 124 cm—takes melatonin for insomnia associated with autistic spectrum disorder (ASD). Melatonin is a pineal hormone that may affect sleep pattern. The patient cannot swallow whole tablets or capsules, therefore he is unable to take Circadin (a prolonged release tablet containing melatonin 2 mg).1 The currently available licensed prolonged release formulation of melatonin in the European Union is not licensed for use in children.1 2 However, clinical experience suggests that when appropriate behavioural sleep interventions fail, melatonin may be of value for treating sleep onset insomnia and delayed sleep phase syndrome in children with conditions such as visual impairment, cerebral palsy, attention deficit hyperactivity disorder, autism and learning difficulties.2 Suggested oral doses are 2–3 mg once daily initially, increased if necessary after 1–2 weeks to 4–6 mg up to a maximum of 10 mg daily.2
The patient was prescribed two to three capsules of immediate release melatonin 3 mg at night—6 mg at bedtime and another 3 mg to be taken if he wakes up in the night.
His parents are giving him 3.5 capsules (by mixing the contents with a drink) at night, that is, 10.5 mg.
The prescriber wants the maximum daily dose not to exceed 9 mg as advised by local guidelines and is concerned that 10.5 mg is too high. The parents say that another healthcare professional has advised them that up to 12 mg daily can be given.
Clinical question
Is there any definitive guidance on the safe maximum daily dose of melatonin for a child with insomnia associated...