Melatonin ordering grief

[trulylovelyperson]

Anyone any suggestions please?

Have been informed that any order for off licence Melatonin Caps requires signed letter from GP conforming to wording dictated by MHRA and company kindly faxed proforma for our use.
GP's have signed this for months now but have suddenly noticed wording that they find offensive and are now saying they refuse to provide this along with new scripts.
Have informed practice manager we cannot order stock unless this is forthcoming. We have vulnerable patients using dosettes containing Melatonin and are currently stuck between rock and hard place awaiting GP's decision on this. Meantime carers are concerned that gap between time of getting letter to us and supplies being dispatched will mean patient care will suffer.
Will be phoning practice manager tomorrow to lay this out - and to be honest will be emailing copy of my request/reasoning etc behind this in order to get this all documented with a view to covering my trulylovelyass...........
Guessing the problem is the acknowledgement that manufacturing standards may not be up to GMP - but pure conjecture on my part.
Do not have the copy of this document at home but 'well known specials importer *D** ' have been as helpful as they can be in the circumstances .
Boy am I fed up tiptoeing around GP's feelings to get stuff done for patients.

[Sir_Dispensalot]

well it's simple. letter is required or pt does not get meds. Alternatively gp could prescribe 2mg tablets (circadin) to the correct dose with no letter needed. But they then have to justify the change to the specialist. Try speaking directly to the gp - be polite but firm in your request - and make it clear that the letter details are not YOUR requirements.

[gigeordie]

(Guessing the problem is the acknowledgement that manufacturing standards may not be up to GMP - but pure conjecture on my part.)

You are quite correct. Imported Melatonin products are not manufactured to GMP standards thus the prescribing doctor must demonstrate they are happy for their patient to recieve such a product by providing the necessary letter.

Some of the commercial specials suppliers are able to supply unlicensed Melatonin manufactured in GMP approved facilites the UK and therefore the letter would not be necessary but these are only available in limited strengths.

[crit care]

i guess if the GPs are unwilling to provide the letters, then i can't see why we should tip toe around them or bend over backwards for alternatives. Get the aptients to go see the GP and ask why they can't get their melatonin. They need to take the responsibility just as much as us pharmacists do. maybe when they get a queue of irate patients waiting in line, then they may buck up their ideas.

Ultimately its in the gp hands, without the letter there is not much else you can do....

[trulylovelyperson]

Thanks for the replies guys
We spend so much time sourcing supplies at the moment it's easy to forget not everything is down to us to fix.......

[crit care]

just out of interest i was able to get out of supplying some melatonin for a patient the other day, just because they werent sleeping they had gone straight in for melatonin, slightly hardcore..got them to use trazadone for night sedation instead, and apparently the patient had a good night sleep! Melatonin isn't quite the wonder drug people think it is!

[bobbin]

just out of interest i was able to get out of supplying some melatonin for a patient the other day, just because they werent sleeping they had gone straight in for melatonin, slightly hardcore..got them to use trazadone for night sedation instead, and apparently the patient had a good night sleep! Melatonin isn't quite the wonder drug people think it is!

What do you mean by hardcore?! Melatonin is available OTC in many countries such as Canada. It is a pretty mild product with limited efficacy.

Trazodone is too long-acting to be used as a sleep aid in most cases. Temazepam would usually be better for short-term or occasional use.

[bobbin]

they find offensive and are now saying they refuse to provide this along with new scripts

OK, so send the script back to the surgery and let them know you cannot dispense it. It's quite simple - it's their decision. I wouldn't worry too much about it. Melatonin is a product with limited efficacy at the best of times.

[crit care]

if someone rocks up and says i can't sleep, i don't think melatonin is the first thing you would recommend for them! trazaone works well as night sedation within a hopsital setting with machines beeping and nurses interfering with you all the time.

[bobbin]

if someone rocks up and says i can't sleep, i don't think melatonin is the first thing you would recommend for them!

No, definitely not.

trazodone works well as night sedation within a hospital setting with machines beeping and nurses interfering with you all the time.

I suppose it's OK for people who don't have to get up in the morning.