Do you require melatonin for the treatment of jetlag?

Are you currently taking any of the following medications (including over the counter, prescription or recreational drugs)?

Benzodiazepines (e.g. Diazepam, temazepam, lorazepam) Zopiclone or Zolpidem (or any other sleeping tablets) Fluvoxamine Oestrogen containing medication (e.g. HRT or combinec contraceptive pill) Warfarin or any other blood thinning medication carbamazepine rifampicin quinolones or fluoroquinolones (e.g. Ciprofloxacin) pipemidic acid teriflunomide leflunomide axitinib

Melatonin, as a medication that helps you sleep, can enhance the effects of sleepiness or low blood pressure when taken with other medications. Below is a list of medications whose side effects could be enhanced by melatonin. Do you understand that if you are on these medications and have any symptoms of light headedness, muzziness or excessive sleepiness you should immediately stop your melatonin?

Alcohol Alpha-blockers (e.g. Doxazocin, Alfuzosin, Tamsulosin, Prazocin) Antidepressants, Tricyclic Antihistamines Antipsychotics Myelosuppressive drugs Baclofen Beta-blockers Calcium-channel Blockers Clonidine Diazoxide Diuretics Guanfacine Hydralazine Lofexidine Methyldopa Minoxidil Mirtazapine Moxonidine Nitrates Opioid Analgesics Phenobarbital Primidone Ritonavir Sodium Nitroprusside Tizanidine

Do you understand that melatonin should be taken daily, 1-2 hours before your intended bedtime in your new time zone?It should only be taken between the hours of 8pm and 4am and should not be taken for more than 5 days.

Do you understand that you should not take melatonin with alcohol?

Do you understand that melatonin can cause drowsiness and therefore you should not drive or operate heavy machinery for at least 8 hours after taking it?

Do you understand that recent studies have suggested melatonin may increase the risk of falls, accidents, memory disturbance, dependence and withdrawal symptoms and an increased risk of dementia?

Do you agree to the following?

You will read the patient information leaflet supplied with your medication You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment. The treatment is solely for your own use You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.

Do you have an allergy to lactose or melatonin?

Do you have any of the following?

Kidney problems Liver problems Heart problems Any Autoimmune condition (e.g. Rheumatoid arthritis, Graves’ disease) Galactose intolerance, LAPP lactase deficiency or glucose-galactose malabsorption Alcohol dependency Depression requiring treatment with medication Schizophrenia or Bipolar Disorder Epilepsy (or ever suffered a seizure)

Are you pregnant or breastfeeding?