23/09/25 (v2.1): Melatonin 1mg/mL liquid amended: off-label status removed and advice that it is second line after melatonin 3mg tablets added.
09/05/23: Added: 'Ceyesto 3mg tablets is the cost effective brand for melatonin. The tablets can be crushed in swallowing difficulties'.
If, after consideration of the use of non-pharmacological measures, hypnotics are considered necessary:
In most cases, hospital patients should ONLY be discharged home with a supply of hypnotics if they were admitted on them and there is good reason to continue. This is particularly important for older patients.
The use of hypnotics with a long half-life such as nitrazepam (non-Formulary) is NOT recommended as they often result in a hangover effect and may lead to accumulation, particularly in older people.
Sedative antihistamines are NOT recommended.
Long-term hypnotic use is associated with falls, road traffic accidents and hip fractures. NHS Highland guidance on Insomnia is under development, for further information see: BNF: Hypnotics and anxiolytics.
NICE guidance April 2004 (www.nice.org.uk) recommends that switching from one hypnotic to another should only occur if a patient experiences adverse effects thought to be directly related to a specific agent. Patients who have not responded to one hypnotic should NOT be prescribed any of the others.
Guidelines:
Self-management information
Patient information:
MHRA advice: Zolpidem: risk of drowsiness and reduced driving ability the next day (December 2014) (www.gov.uk)
Tablets 5mg, 10mg
10mg at bedtime. Older or debilitated patients 5mg at bedtime.
Tablets 3·75mg, 7·5mg
7·5mg at bedtime. Older or debilitated patients initially 3·75mg at bedtime increased if necessary.
MHRA advice: Drugs and driving: blood concentration limits to be set for certain controlled drugs in a new legal offence (December 2014) (www.gov.uk)
Tablets 10mg (CD schedule 3)
10 to 20mg at bedtime, exceptional circumstances 30 to 40mg. Older or debilitated patients 10mg at bedtime, exceptional circumstances 20mg.
Oral solution 10mg/5mL (CD schedule 3)
10 to 20mg at bedtime, exceptional circumstances 30 to 40mg. Older or debilitated patients 10mg at bedtime, exceptional circumstances 20mg.
Tablets 3mg (specialist recommendation only)
Ceyesto brand is the cost-effective choice. It is licensed for: Insomnia in children and adolescents aged 6 to 17 years with ADHD, where sleep hygiene measures have been insufficient.
To be used for sleep onset difficulties in children as per Sleep pathway (Paediatric Guidelines).
In swallowing difficulties the tablets can be crushed and mixed with a small amount of water or soft food for administration.
Oral solution 1mg/ml (specialist recommendation only)
Second line after melatonin 3mg tablets for sleep onset difficulties in children as per Sleep pathway (Paediatric guidelines).
For patients with enteral feeding tubes, a polypharmacy review should be conducted and, if melatonin is to be continued, advice from the Community Paediatrician should be sought for suitable formulations. See Highland unlicensed/off-label medicines list.
TAM (Treatments and Medicines) NHS Highland