Off-label use of antipsychotics and associated factors in community living older adults

Bakouni, Hamzah; Berbiche, Djamal; Vasiliadis, Helen‐Maria

doi:10.1080/13607863.2017.1401583

Cited by 9 publications

(5 citation statements)

References 36 publications

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“…In our study, age, sex, region, years, department, antipsychotic type, drug expenses, polypharmacy frequency and number of diagnoses were found to be associated with off-label prescriptions, which was essentially consistent with the findings of other studies [37][38][39][40]. However, the risks for off-label prescriptions of female sex and SGAs were greater in our study, which was different from the results obtained in the Netherlands [40] and United States [39].…”

Section: Discussionsupporting

confidence: 83%

Trends and off-label utilization of antipsychotics in children and adolescents from 2016 to 2021 in China: a real-world study

Zhaojian,

Meizhu,

Jun

et al. 2024

Child Adolesc Psychiatry Ment Health

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Background Global antipsychotic usage, including off-label prescriptions, has increased in recent decades. However, trends in China, particularly for children and adolescents, remain unclear. This study explored these trends from 2016 to 2021 and identified factors associated with off-label prescriptions. Methods In this retrospective study, we analyzed on-label and off-label prescriptions based on drug information approved by the China National Medical Products Administration. To identify factors associated with off-label prescriptions, we conducted multivariate logistic regression analysis. Results Our study included 48,258 antipsychotic prescriptions, 52.4% (25,295) of which were prescriptions for males. Of these, 61.7% (29,813) were off-label. Over time, the number of antipsychotics and the percentage of off-label prescriptions for children and adolescents overall increased from 2016 to 2021. The use of atypical antipsychotics increased, whereas that of typical antipsychotics decreased. For off-label usage, all of the factors in our study were associated with off-label usage, including age, sex, year, region, department, reimbursement, antipsychotic type, drug expense, number of polypharmacy and diagnoses. Additionally, tiapride (15.8%) and aripiprazole (18.6%) were the most common typical and atypical antipsychotics, respectively. For pediatric diseases, common diagnoses included mood or affective disorders (31.7%) and behavioral and emotional disorders, with onset usually occurring in childhood and adolescence (29.1%). Furthermore, a depressive state was the most common diagnosis for which antipsychotic polypharmacy was used for treatment. Conclusion In this retrospective study, off-label antipsychotic prescriptions were common, with trends generally increasing among children and adolescents from 2016 to 2021. However, there is a lack of evidence supporting off-label usage, thus emphasizing the need for studies on the efficacy and safety of these treatments.

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Section: Discussionsupporting

confidence: 83%

Trends and off-label utilization of antipsychotics in children and adolescents from 2016 to 2021 in China: a real-world study

Zhaojian,

Meizhu,

Jun

et al. 2024

Child Adolesc Psychiatry Ment Health

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“…Furthermore, atypical antipsychotics have been found to be effective as an adjuvant medication in major depressive disorder in patients with inadequate responses to selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors, and quetiapine has been found to be effective as a monotherapy for major depressive disorder (34). Limited data suggest possible efficacy in other conditions, such as obsessive-compulsive disorder and posttraumatic stress disorder (35), but in general these medications tend to be used frequently for off-label conditions and nonspecific symptoms in a variety of contexts, including insomnia (6,36). Widespread use of atypical antipsychotics is of concern given the observed risk for adverse outcomes and mortality, particularly in older adults (5,28,37).…”

Section: Discussionmentioning

confidence: 99%

Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults

Kheirbek

Fokar

Little

et al. 2019

The Journals of Gerontology: Series A

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Background Antipsychotics are prescribed to treat various symptoms in older adults, however, their safety in this context has not been fully evaluated. The objective was to evaluate mortality risks associated with off-label use of antipsychotics among older adults with no preexisting mental illness or dementia relative to those with diagnosis of dementia. Methods Data (2007–2015) were derived from Department of Veterans Affairs registries for 730,226 patients (≥65 years) with no baseline serious mental illness, dementia). We estimated the cumulative incidence of antipsychotics prescription and 10-year all-cause mortality. The extended Cox models were used to estimate Hazard Ratios (HRs) associated with antipsychotics prescription, adjusted for time-varying covariates, dementia diagnosis, comorbidity index score, and age at time of first exposure to antipsychotics. Results The study included 98% males, 13% African Americans, and 81% Caucasian. Patients with dementia and antipsychotics had the highest risk of mortality (78.0%), followed by (73.0%) for patients with dementia alone and compared with patients without dementia or antipsychotics exposure who had the lowest mortality risk (42.0%). Exposure to typical antipsychotics was associated with (HR: 2.1, confidence interval [CI] 2.0–2.2) compared with atypical antipsychotics (HR: 1.5, CI 1.4–1.5, p = <.0001). Conclusion In a large cohort of older adults, antipsychotics were associated with an increased risk of all-cause mortality. While significant increase in mortality was attributable to the diagnosis of dementia, the addition of antipsychotics resulted in added mortality risk among all patients. Antipsychotic medications should be used cautiously in all older adults, not only those with dementia.

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“…These data are consistent with a study conducted in Pakistan, which found that CNS medicines were the most often administered off-label prescription (28.5%). 27 Phenobarbitone (16.1%) was the most regularly administered off-label medication, followed by phenytoin (15.2%). However, this finding differs from a study conducted in Indonesian hospitals, which revealed that ranitidine is the most commonly prescribed off-label medication for children.…”

Section: Discussionmentioning

confidence: 99%

“…However, when compared to other study findings from around the world, this study's outcome was lower, with off-label medication ranging from 36.3% to 85%. [24][25][26][27] The disparities could be due to changes in the availability of pediatric-approved drugs, differing study designs, sample sizes, or pediatric medication use policies.…”

Section: Discussionmentioning

confidence: 99%

Off-label medication use in pediatrics and associated factors at public hospitals in east Gojjam zone, Ethiopia

et al. 2022

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Objective: Due to a lack of appropriate pediatric preparations, health providers frequently use adult formulations in an off-label manner. This study aimed to assess pediatric off-label medication use patterns and associated factors in East Gojjam, Ethiopia. Methods: Institutional-based cross-sectional study was conducted from December 2020 to June 2021 at three randomly selected hospitals. Data were collected by using self-structured questionnaires and a data abstraction checklist from health care workers and prescriptions, respectively. The collected data were analyzed using SPSS version 25. Logistic regression analysis was used to assess the association between independent and dependent variables. Results: A total of 285 eligible health professionals from the pediatric unit and pharmacies, and 1,800 eligible prescriptions were involved in the study. The response rate of healthcare workers was 94.37%. Around 74.4% of professionals had good knowledge about off-label medication. Only 8% of participants had taken training on pediatric off-label medications. Of all prescriptions, 27.6% of them have contained at least one off-label medication. Phenobarbitone (16.1%) and phenytoin (12.7%) were the most frequently prescribed off-label medication. In all, 496 (27.6%) prescriptions contained off-label drugs in the form of overdose, cutting adult tablets into small portions, and formulating tablets/capsules into solution. Lack of information on off-label prescribing, shortage of pediatric drugs, and suitable dosage forms showed significant association with off-label prescribing with p-value < 0.001. Conclusion: Almost one-third of pediatric prescriptions contained off-label medication. Only a small number of healthcare workers had taken training on pediatric off-label medications. Lack of sufficient information on risks of off-label medication, shortage of pediatric medication, and suitable pediatric dosage forms were associated with the use of off-label medication compared to non-use. Further research should be done on the long-term effects associated with off-label prescribing in pediatrics to assess whether the potential risks are balanced with the therapeutical benefit.

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Off-label use of antipsychotics and associated factors in community living older adults

Cited by 9 publications

References 36 publications

Trends and off-label utilization of antipsychotics in children and adolescents from 2016 to 2021 in China: a real-world study

Trends and off-label utilization of antipsychotics in children and adolescents from 2016 to 2021 in China: a real-world study

Association Between Antipsychotics and All-Cause Mortality Among Community-Dwelling Older Adults

Off-label medication use in pediatrics and associated factors at public hospitals in east Gojjam zone, Ethiopia

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