Abstract

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.

Highlights

  • 16 psychiatrists provided their consent to participate in the study; two of them refused at the time of the interview because of their busy schedules

  • As far as we possibly know, this is the first qualitative study conducted in a Pakistani setting on psychiatrists’ knowledge, attitudes, and practices related to the use of Off-label drug prescription (OLDP)

  • The current study discovered gaps in respondents’ knowledge, even though they were well informed about the definition of OLDP

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Summary

Introduction

Medication prescription for off-label reasons is becoming more prevalent; recent occurrences depicted such prescribing as one of the pillars of evolving clinical therapy. Off-label drug prescription (OLDP), by doctors across all medical specialties has increased significantly in preceding decades because it allows them to employ novel treatment alternatives based on the most recent data [2]. Many physicians consider that OLDP has a significant role in therapeutic practice, representing the optimum way to utilize that treatment, and it is frequently required when treating certain patients, such as those whose symptoms have proved resistant to a variety of therapeutic options [4]. Peer-reviewed publication publishes information regarding novel applications of medication which allows the physicians to use innovative therapeutic choices based on the most recent research [5]. The inappropriate use of OLDP could generate serious concerns regarding efficacy, safety, and adverse drug reactions (ADRs) as observed in previous research [6,7]

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