4CPS-015 Therapeutic optimisation in older inpatients: is melatonin a real deal?

<h3>Background and Importance</h3> Melatonin is used for treating insomnia or circadian rhythm sleep-wake disorders. For frail older inpatients with sleep deprivation its use might be interesting to reduce polypharmacy and consumption of benzodiazepines (BZD) or hypnotic drugs with potential serious adverse effects. In our country, drugs containing melatonin aren’t reimbursed due to a lack of evidence of efficiency. Our hospital has referenced it, despite sub-costs, for the treatment of insomnia in patients with Lewy-Body Dementia (LBD). <h3>Aim and Objectives</h3> This study’s aim is to assess the compliance of Melatonin prescriptions with our Drug Committee referencing criteria, the co-prescription rate of Melatonin with BZD/hypnotics and the rate of continuation of Melatonin by the patient within 6 months of hospitalisation. <h3>Material and Methods</h3> All prescriptions of Melatonin in patients aged over 75, hospitalised in acute medicine unit, between 1 June and 30 November 2023 were included in this retrospective cohort study. The variables collected were: age, sex, diagnostic of LBD, insomnia symptoms, history of falls, prescription of BZD/hypnotics, treatment follow-up after 6 months (city pharmacies or residential care facilities were contacted). <h3>Results</h3> The study included 96 patients (55.2% female, mean age 86.2 ± 5.9 years). Among them, 4 (4.2%) had a LBD diagnosed. Melatonin was prescribed with BZD/hypnotics for 62.5% of patients during hospitalisation – most of them (68.3%) having a history of falls. Fewer patients reported sleep improvement on melatonin only (7.5%) than with an addition of another drug (43.4%). The continuation rate 6 months after discharge is 38.9%: the reasons given for discontinuing Melatonin were inefficiency and cost. However, 85.7% of those patients are still treated with BZD/hypnotics. <h3>Conclusion and Relevance</h3> Few prescriptions meet our referencing criteria. Although it has been used with wider indications, Melatonin has difficulties to demonstrate its efficacy in improving the drug management of elderly inpatients as the co-prescription rate with BZD/hypnotics is important. Pharmacist-led interviews with an aim of deprescribing those drugs might be a support for the medical team to find a more secure way to treat insomnia than using profusely a ‘trendy’ – but expensive- drug. Large-scale clinical trials are needed to determine its impact on older inpatients (relevant dosage, indication) and consider possible reimbursement. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest