Off-Label Prescribing in Pediatric Outpatients

Abstract

To study the characteristics of off-label prescribing and adverse drug reaction (ADR) occurrence in a sample of pediatric outpatients treated by general practitioners.METHODS: A survey on pediatric drug prescribing was implemented in 46 general practices in southwestern France. All consecutive patients aged 0 to 16 years were included. Patient characteristics, reasons for consultation, and drug prescribed (including indications) were collected. ADRs occurring #10 days after the date of consultation were recorded by the general practitioners (spontaneous notification). Off-label prescription was defined as prescribing outside the specifications of the Summary of Product Characteristics.RESULTS: Among the 2313 children seen between March 8, 2011 and July 31, 2011, 1960 were exposed to $1 prescribed drug. Mean age was 5.6 years, with a gender ratio of 1.1. Among children with prescriptions, 37.6% (n = 736) were exposed to $1 off-label prescription and 6.7% (n = 132) to $1 unlicensed drug. Off-label prescribing involved an unapproved indication in 56.4% of cases (n = 416), a lower dosage (26.5%, n = 195) or higher dosage (19.5%, n = 144) than specified, age not labeled (7.2%, n = 53), incorrect route of administration (3.5%, n = 26), and contraindication (0.3%, n = 2). A total of 23 ADRs were reported (1.5% of patients with off-label prescriptions). ADR occurrence was not significantly related to off-label drug prescribing.CONCLUSIONS: Despite the numerous initiatives implemented for promoting rational medicine use in children, the prevalence of off-label prescription in outpatient pediatric practice remains high.

Penggunaan Obat Off-Label pada Anak di Apotek Kota Yogyakarta

“…Prevalensi penggunaan obat off-label terutama pada anak sangat tinggi di sejumlah negara [2,3,4,5]. Penelitian di Jerman menunjukkan penggunaan obat off-label tergolong tinggi terutama kategori offlabel dosis [6].…”

Clinical Research in Paediatrics: What Can We Do?

“…Poor evidence for safe and effective drug use in paediatric patients represents a clinical burden. In fact, 70 % of prescribed medications are estimated to be off-label, laying patients open to a high risk of adverse effects [2][3][4]. Isn't this an ethical issue too?…”

Clinical Drug Development in Epilepsy Revisited: A Proposal for a New Paradigm Streamlined Using Extrapolation

“…Off-label prescribing in paediatrics is prevalent in the USA [4] and EU [5]. In routine clinical practice, informal extrapolation from adult data increases the confidence of doctors and families regarding off-label prescribing in children.…”