Abstract
BackgroundOff-label prescribing of psychoactive drugs is a common practice in psychiatry. Here, we sought to investigate the frequency of off-label prescribing in a population of hospitalized patients with a somatic illness who were also suffering from a psychiatric pathology.MethodsUsing a prospective, observational design, we collected data from 982 hospitalized patients with a somatic illness for whom a psychiatric consultation was requested because of the presence of additional psychiatric symptoms. Data were collected at three hospitals in Germany. Demographic and clinical data, including the previous psychoactive medications and an assessment of the suitability of the previous medications, were recorded and analyzed.ResultsData on the previous psychiatric medications were available for 972 patients. In 16.6% of patients, at least one psychoactive drug had been prescribed off-label, 20.2% had received on-label medication, and 63.2% had not received any psychiatric medication. Among all patients receiving psychiatric medication, 45.1% had received off-label medication. The logistic regression analysis showed a significant influence of age on the likelihood of receiving off-label medication (p = 0.018). Benzodiazepines were the most frequent off-label prescription (25.8% of off-label prescriptions), followed by atypical antipsychotics (18.2%) and low-potency antipsychotics (17.2%). Notably, 57.1% of off-label prescriptions were judged to be ‘not indicated’ by experienced psychiatrists.ConclusionsOur data show a high frequency of the off-label prescription of psychoactive drugs by physicians treating patients with somatic illnesses in general hospitals. Because more than half of these cases were judged to be “not indicated”, these prescriptions indicate a potential risk to patients. Furthermore, the classes of drugs that were most frequently prescribed off-label, benzodiazepines and antipsychotics, both show a substantial risk profile, particularly for elderly patients.
Highlights
Off-label prescribing of psychoactive drugs is a common practice in psychiatry
A subsequent United Kingdom (UK) study analyzing inpatient prescriptions in psychiatric wards reported an offlabel prescription rate of 7.5% [5], whereas another study conducted in a German Psychiatric hospital found that 20% of prescriptions were clearly off-label and another 19% of prescriptions were classified as “probably offlabel” [6]
We examined the number of off-label prescriptions of psychotropic drugs for patients who were hospitalized due to a somatic illness and showed additional psychiatric pathology
Summary
Off-label prescribing of psychoactive drugs is a common practice in psychiatry. Here, we sought to investigate the frequency of off-label prescribing in a population of hospitalized patients with a somatic illness who were suffering from a psychiatric pathology. Off-label prescribing, the prescription of drugs not licensed for the intended use in the country of conduct, is a common phenomenon. A subsequent UK study analyzing inpatient prescriptions in psychiatric wards reported an offlabel prescription rate of 7.5% [5], whereas another study conducted in a German Psychiatric hospital found that 20% of prescriptions were clearly off-label and another 19% of prescriptions were classified as “probably offlabel” [6]. These studies were conducted more than 15 years ago. Classes of drugs that are commonly prescribed off-label very in psychiatric practice are antipsychotics [5, 8] and benzodiazepines [7, 9], the latter of which is often being prescribed off-label for long-term use
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