Objective:1) To evaluate the relationship between physician-pharmacist agreement about
the off-label drug use and 2) and to identify the most common off-label
medication category/indications and prescriber clinical disciplines in
private settings in Baghdad area, IraqMethods:This study evaluated 980 off-label use requests in the private clinical
settings within Baghdad area, Iraq from October 2013 to September 2015. The
efficacy, safety, and convenience of each drug request and its alternative
options were evaluated according to the patient health and demographic
characteristics and standard guidelines.Results:Of the 980 physician off-label requests, only 22.7% were approved by
the pharmacists. Rheumatology and Nephrology accounted for the highest ratio
of off-label use requests for adults (30.3% and 26.3%). The
pharmacist rejection ratio of off-label use was comparable between the two
groups (p>0.05). Most of the issued requests were attributed either
to unapproved indication or to combination of more than one drug (38%
and 35.3%). A low acceptance rate was reported in the requests issued
for treatment in different clinical lines to the authorized one
(11.9%). The lowest rate of acceptance was reported in the requests
that had very low evidence level (9.1%). The mostly prescribed
medications were musculoskeletal agents (28.9%). Finally,
78.2% of the requests came from clinical branches for adults.
Although the agreement rate for requests in adults was higher than that in
pediatrics, the two rates were not significantly different.Conclusion:Community pharmacists should effectively take responsibility for assessing
off-label drug requests in Iraqi private settings. The quality of evidence
does not represent the major factor influencing the approval rate of
off-label drug use. The availability of safer and/or affordable alternatives
and prescribing for a different patient age category highly impacted the
pharmacists’ approval rate.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.