Impact of delisting melatonin from a health-system formulary on psychotropic utilization

ObjectiveTo characterize the trends of psychotropic utilization before and after the formulary removal of melatonin in Alberta, Canada.MethodsWe conducted a retrospective drug utilization review of patients admitted to inpatient, long-term care, and pediatric units who received psychotropics for insomnia treatment. Utilization patterns were compared between two periods; pre-removal: January to December 2023 and post-removal: October 2024 to March 2025. Data were analyzed using defined daily dose per 1000 patient-days (DDD/1000PD).ResultsA total of 101 pre-removal and 115 post-removal sites were included. There was a 13.5% relative decrease in psychotropic use, from 731.83 to 632.78 DDD/1000PD. Melatonin use decreased from 95.60 to 13.94 DDD/1000PD. In the post-removal period, the psychotropic classes with the highest utilization rates were benzodiazepines (203.26 DDD/1000PD), Z-drugs (167.78 DDD/1000PD), and antidepressants (148.75 DDD/1000PD). The overall use of antidepressants increased by 17.3% while Z-drugs and benzodiazepines decreased by 8.8% and 8.4%, respectively.ConclusionsThe temporal trends of psychotropics varied among zones, sites, and years within the same site. Overall, there was a decrease in psychotropic utilization, largely driven by decreases in the use of Z-drugs and benzodiazepines. The findings should be interpreted with caution, as results may not be generalizable to other institutions.