Off-label Psychotropics Use: Isn't it Now an Inevitable and a “Norm” in Psychiatry?

Khanra, Sourav; Das, Basudeb

doi:10.4103/ijpsym.ijpsym_563_17

Cited by 11 publications

(11 citation statements)

References 11 publications

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“…The OLDP patterns in our study revealed a higher off-label use of benzodiazepines which is not parallel to other studies [2,37]. This might be due to a difference in morbidity pattern, as in our setting, the patients are commonly presenting with depression and schizophrenia, for which psychiatrists prescribed longer use of benzodiazepines to treat insomnia and decrease aggressive symptoms [38].…”

Section: Discussioncontrasting

confidence: 90%

Patterns and Predictors of Off-Label Drug Prescribing in Psychiatric Practice: A Qualitative Study

Shakeel

Nesar²,

Rehman

et al. 2021

Pharmacy

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Off-label drug prescribing (OLDP) must be based on strong scientific evidence to make sure that patients get the optimum therapeutic outcomes. Adherence to the prerequisites is determined by the physicians’ attitude and knowledge. In this context, the present study was conducted with the goal of investigating psychiatrists’ perceptions of the use of OLDP in their clinical practice. A total of 14 psychiatrists were interviewed using a semi-structured interview guide. Thematic content analysis was performed. Data saturation was achieved at the 12th interview. Six major themes and fifteen subthemes emerged from qualitative interviews. Among the major themes were knowledge and concepts about the off-label drugs, attitude and current practice of prescribing off-label drugs, and rationale of prescribing and suggestions for reducing the use of off-label drugs. Almost all of the respondents interviewed provided detailed comments concerning the OLDP concept, depicted an optimistic approach and deemed that OLDP is quite common in psychiatry. Off-label usage of benzodiazepines such as clonazepam, diazepam and lorazepam in mania, depression, and obsessive–compulsive disorder were commonly reported. It was observed that the majority of the respondents did not inform the patients before prescribing off-label drugs. The present findings revealed that respondents had awareness; however, they depicted diverse attitudes towards prescribing off-label drugs. Further education and sensitization in regions with impoverished knowledge would certainly assist in preventing the risks associated with the use of OLDP.

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Section: Discussioncontrasting

confidence: 90%

Patterns and Predictors of Off-Label Drug Prescribing in Psychiatric Practice: A Qualitative Study

Shakeel

Nesar²,

Rehman

et al. 2021

Pharmacy

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“…The last important finding is that the CP interventions were significantly related to better treatment adherence for antidepressants and antipsychotics. Psychotropic drugs are commonly used outside of their approved indications, which is often unavoidable in clinical practice 32 . However, some drugs for mental disorders are prescribed to patients for indications not in line with treatment guidelines: e.g., quetiapine as a hypnotic for the treatment of insomnia, which was also frequent in our study 33 .…”

Section: Discussionmentioning

confidence: 99%

Clinical pharmacist interventions in ambulatory psychogeriatric patients with excessive polypharmacy

Štuhec

Zorjan

2022

Sci Rep

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Psychogeriatric primary care patients are frequently treated with excessive polypharmacy (≥ 10 medications), leading to complications and increased costs. Such cases are rarely included in treatment guidelines and randomized controlled trials. This paper evaluates the impact of clinical pharmacist medication reviews on the quality of pharmacotherapy in primary care psychogeriatric patients with excessive polypharmacy. The retrospective observational multicentric pre-post study included patients (aged 65 or above) treated with at least one psychotropic and ten or more medications. Clinical pharmacists’ recommendations were retrieved from medication review forms for the period 2012⁠–⁠2014. The study outcome measures were the number of medications, potentially inappropriate medications in the elderly (PIMs), potential drug-drug interactions which should be avoided (pXDDIs), and adherence to treatment guidelines. The study included 246 patients receiving 3294 medications, of which 14.6% were psychotropics. The clinical pharmacists proposed 374 interventions in psychopharmacotherapy. The general practitioners accepted 45.2% of them (169). Accepting clinical pharmacist recommendations reduced the total number of medications by 7.5% from 13.4 to 12.4 per patient (p < 0.05), the total number of prescribed PIMs by 21.8% from 312 to 244 (p < 0.05), the number of pXDDIs by 54.9% from 71 to 31 (p < 0.05) and also improved treatment guidelines adherence for antidepressants and antipsychotics (p < 0.05). Clinical pharmacist interventions significantly improved the quality of psychopharmacotherapy by reducing the total number of medications, PIMs, and pXDDIs. Accepting clinical pharmacist interventions led to better treatment guidelines adherence.

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“…The combination of phentermine and lisdexamfetamine is not approved by the Federal Drug Agency for binge-eating disorder or obesity. However, it is well known that many medications used by psychiatrists and other providers are ‘off-label’, with the intent of providing benefits to the patient [ 11 , 12 ] . Determination of ‘off-label’ use is a careful clinical decision made by an informed patient and the prescribing physician [ 12 ] .…”

Section: Discussionmentioning

confidence: 99%

“…However, it is well known that many medications used by psychiatrists and other providers are ‘off-label’, with the intent of providing benefits to the patient [ 11 , 12 ] . Determination of ‘off-label’ use is a careful clinical decision made by an informed patient and the prescribing physician [ 12 ] . Any off-label use has to wisely balance the possible benefits and potential harms [ 13 ] .…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy Due to Combined Use of Phentermine and Lisdexamfetamine

Burleigh

Birgit

2020

European Journal of Case Reports in Internal Medicine

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Objectives: This is the first case report of iatrogenic Takotsubo syndrome (TS) due to a combination of lisdexamfetamine and phentermine. Background: TS is characterized by transient acute ballooning of the left ventricular wall. Typically, it occurs in extremely stressed post-menopausal women, however a few iatrogenic causes have been described recently. Results: A 55-year old woman prescribed lisdexamfetamine and phentermine, presented with acute substernal chest pain. Acute coronary syndrome was excluded. The echocardiogram was diagnostic of TS, and she recovered spontaneously, with supportive care. Conclusion: Caution with the use of sympathomimetic medications in post-menopausal women appears warranted.

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Off-label Psychotropics Use: Isn't it Now an Inevitable and a “Norm” in Psychiatry?

Cited by 11 publications

References 11 publications

Patterns and Predictors of Off-Label Drug Prescribing in Psychiatric Practice: A Qualitative Study

Patterns and Predictors of Off-Label Drug Prescribing in Psychiatric Practice: A Qualitative Study

Clinical pharmacist interventions in ambulatory psychogeriatric patients with excessive polypharmacy

Takotsubo Cardiomyopathy Due to Combined Use of Phentermine and Lisdexamfetamine

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