Off‐label quetiapine prescribing in general hospital inpatients: an Australian experience

Abstract

Background Quetiapine is frequently prescribed off‐label in the community but little is known about the initiation and use of quetiapine in general (non‐psychiatry) hospital settings. Aim This study examined the extent of off‐label quetiapine prescribing and rates of initiation of quetiapine in a general inpatient population of an Australian inner city teaching hospital, as well as the frequency of communication with community prescribers following discharge. Methods A retrospective observational study was conducted of all patients admitted under all non‐psychiatric teams and prescribed quetiapine within a tertiary teaching hospital between 1 January 2011 and 31 December 2016. All quetiapine prescribing information was extracted from an electronic medication management system (EMMS) and medical records were reviewed for a random sample of 100 patients prescribed quetiapine. Results EMMS data indicated that 793 people were prescribed quetiapine over the study period. Quetiapine was most frequently prescribed once daily, with a median daily dose of 100 mg (interquartile range 37.5–200 mg). Eighty‐seven of the 100 medical records reviewed had corresponding discharge summaries, and potentially off‐label quetiapine prescribing was found in 48 people (55%); the most frequent off‐label indication was for agitation or delirium. Of the 33 people who had quetiapine initiated in hospital, 26 prescriptions (79%) were for off‐label indications. Of the 11 prescriptions (33%) continued at discharge, only three (27%) discharge summaries contained instructions to community prescribers regarding quetiapine. Conclusion Off‐label prescribing of quetiapine was common in this sample of inpatients, and senior hospital staff should remain cautious of quetiapine prescribing for indications where the evidence of harms and benefits remains unclear. Communication with community prescribers could also be improved to reduce the risk of conversion from intended short‐term off‐label use to longer‐term use.

Ongoing challenges of off-label prescribing

“…For example, off-label prescribing of quetiapine occurs in hospital for insomnia or agitation associated with delirium or dementia. 7 , 8 General practitioners may feel pressured to continue to prescribe quetiapine after a patient is discharged from hospital.…”