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Off-label prescribing by psychiatrists

  • Richard Hodgson (a1) and Ravindra Belgamwar (a2)
Abstract
Aims and Method

To report on the use of atypical antipsychotics in one health district by examining secondary care prescribing patterns for these medicines in North Staffordshire between 1994 and 2001. With one exception, these drugs were licensed solely for use in schizophrenia during the study period.

Results

A total of 502 patients were initiated on atypical antipsychotics in the study period. Of these, 297 (59.2%) had a diagnosis of schizophrenia (ICD–10 codes F20–29). Off-label prescribing was common, but psychiatrists were least likely to prescribe clozapine off-label (2.2%). Affective (18.4%) and organic disorders (12.4%) were the main disorders treated off-label. Olanzapine had the highest off-label use (44.5%).

Clinical Implications

The high off-label use of atypical antipsychotics has clinical and economic implications. Although off-label prescribing may be in the patient's best interests, they should be informed and give their consent. Commissioning bodies, such as primary care organisations, are basing their budgets on guidance from the National Institute for Clinical Excellence, which can have implications for funding this off-label use.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Ashcroft, D. M., Frischer, M., Lockett, S., et al (2002) Variations in prescribing atypical antipsychotic drugs in primary care: cross-sectional study. Pharmacoepidemiology and Drug Safety, 11, 285289.
Boardman, A. P., Hodgson, R. E., Lewis, M., et al (1997) Social indicators and the prediction of psychiatric admission in different diagnostic groups. British Journal of Psychiatry, 171, 457462.
British Medical Association & Royal Pharmaceutical Society (2002) British National Formulary. London & Wallingford: BMJ Bookshop & Pharmaceutical Press.
Committee on Safety of Medicines (2004) Atypical antipsychotic drugs and stroke. http://www.mhra.gov.uk/home/groups/pl-p/documents/drugsafetymessage/con019488.pdf
Conroy, S., Choonara, I., Impiciatore, P., et al (2000) Survey of unlicensed and off-label drug use in paediatric wards in European countries. BMJ, 320, 7982.
Consumers' Association (1992) Prescribing unlicensed drug or using drugs for unlicensed indications. Drug and Therapeutics Bulletin, 30, 9799.
Douglas-Hall, P., Fuller, A. & Gill-Banham, S. (2001) An analysis of off-licence prescribing in psychiatric medicine. Pharmaceutical Journal, 267, 890891.
Healy, D. (2002) The Creation of Psychopharmacology. Cambridge, MA: Harvard University Press.
Henry, V. (1999) Off-label prescribing Legal implications. Journal of Legal Medicine, 20, 365383.
Henry, V. (1999) Off-label prescribing. Legal implications. Journal of Legal Medicine, 20, 365383.
Lenzer, J. (2004) Pfizer pleads guilty, but drug sales continue to soar. BMJ, 328, 1217.
Lowe-Ponsford, F. & Baldwin, D. (2000) Off-label prescribing by psychiatrists. Psychiatric Bulletin, 24, 415417.
National Institute for Clinical Excellence (2002) Guidance on the Use of Newer (Atypical) Antipsychotic Drugs for the Treatment of Schizophrenia. London: NICE.
McIntyre, J., Conroy, S., Avery, A., et al (2000) Unlicensed and off label prescribing of drugs in general practice. Archives of Disease in Childhood, 83, 498501.
Shannon, C. (2003) Money must be made available for NICE guidance, minister says. BMJ, 327, 1368.
World Health Organization (1993) The ICD–10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: WHO.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Off-label prescribing by psychiatrists

  • Richard Hodgson (a1) and Ravindra Belgamwar (a2)
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eLetters

Off label prescribing by child and adolescent psychiatrists

Anne Thompson, Consultant Psychiatrist
14 July 2006

We read with interest Hodgson and Belgamwar’s account of off-label prescribing by psychiatrists (Hodgson and Belgamwar, 2006). Children under 16 were not apparently included in the survey. If they had been, wesuggest that more prescribing of atypical antipsychotic medication for unlicensed applications would have been revealed.

A growing number of UK child and adolescent psychiatrists are prescribing psychoactive drugs. Atypical antipsychotic medication, most commonly risperidone, is prescribed to children to help in the management of severe aggression complicating autistic spectrum disorder (Volkmar et al, 2004), treatment resistant ADHD and aggression associated with disruptive behaviour disorders (Taylor et al, 2004). Risperidone is not licensed for any of these indications, but can be effective. Even when being used for the treatment of early onset schizophrenia, risperidone is not licensed for use in children less than 15 years of age.

Child and adolescent psychiatrists are used to having to use most psychoactive medications off-label. In fact many drugs given to children to treat all manner of medical, surgical and mental health conditions do not have a product license for use in this age group: over two thirds of children admitted to wards in five European hospitals received drugs prescribed in an unlicensed or off-label manner (Conroy et al ,2000). We agree with Hodgson and Belgamwar that issues of informed consent are very important in off-label prescribing. A policy statement and patient information leaflets are available to support off-label prescribing for children (Royal College of Paediatrics and Child Health, 2000). In the absence of an established evidence base for using a drug for an unlicensedapplication, prescribers should look to keep their practice in line with their peers. The national network of paediatric psychopharmacology special interest groups are one source of peer group supervision and support for child & adolescent psychiatrists.

Although in any one health district, the economic impact of a few children being prescribed atypical antipsychotic medication at any one time will be small, the clinical and governance implications of this practice need to be recognized by Trusts and commissioners.

Yours sincerely

Dr Anne ThompsonMB BS MRCP (UK) MRCPsychConsultant Child & Adolescent Psychiatrist

Dr Manash Chattopadhyay MB BS MRCPsychSenior House Officer in Psychiatry

Declaration of interest : None

References

Conroy, S., Choonara, I., Impicciatore, P., et al (2000) Survey of unlicensed and off label drug use in paediatric wards in European countries. British Medical Journal, 320, 79–82.

Hodgson, R., & Belgamwar, R. (2006) Off- label prescribing by psychiatrists. Psychiatric Bulletin, 30, 55-57.

Royal College of Paediatrics and Child Health (2000) The use of unlicensed medicines or licensed medicines for unlicensed applications in paediatric practice : Policy statement produced by the joint RCPCH/NPPG standing committee on medicines. London : Royal College of Paediatrics andChild Health.

Taylor, E., Dopfner, M., Sergeant, J., et al (2004) European clinicalguidelines for hyperkinetic disorder – first upgrade. European Child And Adolescent Psychiatry, 13, Supplement 1.

Volkmar, F. R., Lord, C., Bailey, A., et al (2004) Autism and pervasive developmental disorder. Journal of Child Psychology and Psychiatry, 45, 135-170.
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Conflict of interest: None Declared

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