Background In Australia, prescription melatonin became a ‘Pharmacist Only Medicine’ for people over 55 with insomnia from June 2021. However, little is known about pharmacists’ views on melatonin down-scheduling and perceived impacts on practice. Aim To explore Australian community pharmacists’ views on and attitudes towards the down-scheduling of melatonin. Method A convenience sample of community pharmacists and pharmacy interns were recruited. Participants completed a survey capturing demographic and professional practice details, and rated their knowledge, beliefs and attitudes towards melatonin. This was followed by an online semi-structured interview. Interviews were guided by a schedule of questions developed using the Theoretical Domains Framework and explored the perceived role of melatonin, preparation/response to down-scheduling, practice changes and patient interactions. Interviews continued until data saturation and were digitally recorded, transcribed verbatim and analysed using the Framework Approach. Results Twenty-four interviews were conducted with community pharmacists (n = 19) and intern pharmacists (n = 5), all practicing in metropolitan areas. Pharmacists/intern pharmacists welcomed the increased accessibility of melatonin for patients. However, pharmacists perceived a disconnect between the guidelines, supply protocols and pack sizes with practice, making it difficult to monitor patient use of melatonin. The miscommunication of eligibility also contributed to patient-pharmacist tension when supply was denied. Importantly, most participants indicated their interest in upskilling their knowledge in melatonin use in sleep, specifically formulation differences and dosage titration. Conclusion While pharmacists welcomed the down-scheduling of melatonin, several challenges were noted, contributing to pharmacist-patient tensions in practice. Findings highlight the need to refine and unify melatonin supply protocols and amend pack sizes to reflect guideline recommendations as well as better educating the public about the risk-benefits of melatonin.

Background In Australia, prescription melatonin became ‘Pharmacist Only Medicine’ for people over 55 with insomnia from June 2021. However, little is known about pharmacists’ views on melatonin down-scheduling and their perceived impacts on practice. Objectives To explore the impact of melatonin down-scheduling on Australian community pharmacists’ practice. Methods A convenience sample of community pharmacists and pharmacy interns were recruited. Participants completed a pre-interview survey capturing demographic and professional practice details, followed by a semi-structured interview. Interviews were guided by a schedule of questions exploring the perceived role of melatonin, preparation/response to down-scheduling, practice changes and patient interactions. Interviews were digitally recorded, transcribed verbatim and analysed using the Framework Approach. Results Twenty-four interviews were conducted with Australian community pharmacists (n = 19) and intern pharmacists (n = 5). Pharmacists/intern pharmacists welcomed the increased accessibility of melatonin for patients. However, pharmacists perceived a disconnect between the guidelines, supply protocols and pack sizes with practice, making it difficult to monitor patient use of melatonin. The miscommunication of eligibility also contributed to patient-pharmacist tension when supply was denied. Importantly, 88% of participants indicated their interest in upskilling their knowledge in melatonin use in sleep, specifically formulation differences and dosage titration. Conclusions This study showed the need to refine and unify supply protocols and amend pack sizes in community pharmacy. With further support and training, pharmacists have the potential to extend their scope of practice in sleep health in tandem with the provision of over-the-counter sleep aids.

Introduction Melatonin is a widely used pediatric sleep aid. While readily available internationally, regulatory changes in Australia have only recently allowed over-the-counter access for patients aged over 55, triggering renewed public interest in melatonin. However, melatonin access for younger patients with sleep disturbances remains a prescription-only medicine. Furthermore, pharmacist opinions about the use of melatonin in pediatric patients remain unexplored. This study aimed to investigate Australian community pharmacists’ perspectives toward melatonin use in school-aged children and adolescents. Methods A qualitative study was conducted in a convenience sample of community pharmacists/interns practicing in metropolitan Sydney. Participants completed an online questionnaire capturing demographic information and practice context. Participants subsequently indicated their interest in participating in an in-depth semi-structured interview. Interviews were guided by a schedule of questions exploring pharmacists’ knowledge, beliefs, and attitudes toward melatonin use in pediatric patients. The interviews were digitally recorded, transcribed verbatim, and analyzed using the Framework Approach to identify emergent themes. Recruitment continued until thematic saturation was reached. Results Twenty-four interviews were conducted with pharmacists (n=19) and interns (n=5). Participants were mostly female (67%) with a mean age of 29.8 (range: 22-56) years. Pharmacists managed 25.3 (1-300) sleep-related inquiries per day on average and received direct product requests for melatonin 15.9 (2-100) times per week. Preliminary analyses identified three key themes: Conflicting Opinions on Safety, Product Cost and Formulation Availability, and Gaps in Clinical Education. Pharmacists’ involvement in pediatric melatonin use has largely been within the domains of dispensing or compounding prescriptions. While melatonin was perceived as a “better choice over other sedatives” for children, pharmacists expressed uncertainty about the evidence base concerning long-term use in younger age groups, relying heavily on physicians for prescribing discretion and patient supervision. The need for affordable proprietary products with flexible dosing options and targeted education around melatonin and circadian sleep health was also expressed by participants. Conclusion Findings allude to the need for greater availability and accessibility of pediatric-specific melatonin formulations, as well as refinement of clinical education resources that specifically address the use of melatonin among school-aged children and adolescents. Support (if any)