Melatonin for Insomnia/Sleep

Pharmacist Name:

Registration Number:

Pharmacy Name:

Patient aged between 18-54 years old:

Are you on other medication(s) including any that you get without a prescription? (Some medicines may interfere with each other, especially blood pressure and diuretic medication).

Do you have any medical conditions?

Melatonin should NOT be used in some situations as it can be harmful.

• Are you pregnant or planning a pregnancy?
• Are you breastfeeding?
• History of severe allergic reactions to melatonin
• Current use of sedatives or other medications affecting sleep without prior consultation
• Serious medical conditions (e.g., autoimmune disorders, seizure disorders) without clearance from a physician
• Do you have high blood pressure or diabetes?
• Do you have depression?
• Do you have any autoimmune conditions (e.g., rheumatoid arthritis, multiple sclerosis, lupus)?
• Do you have liver or kidney problems (hepatic or renal impairment)?
• Have you taken Melatonin for longer than 1 month continuously without improvement?

Checklist