Off-label use of drugs in pediatrics: a scoping review

Meng, Min; Lv, Meng; Yang, Bo; Jiao, Panpan; Lei, Wenjuan; Lan, Hui Y.; Shen, Quan; Luo, Xufei; Zhou, Qi; Yu, Xuan; Xun, Yangqin; Lei, Ruobing; Hou, Tianchun; Chen, Yaolong; Li, Qiu

doi:10.1007/s00431-022-04515-7

Cited by 7 publications

(2 citation statements)

References 47 publications

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“…In this study, half of the psychiatrists reported that they were more likely to avoid off-label prescribing. This is despite much of the prescribing in child and adolescent psychiatry being off label (Meng et al 2022;Sharma et al 2016) and most of hospital and primary care paediatric prescribing also being off label (Kimland & Odlind 2012). Off-label use is driven by the high costs of conducting paediatric research and low returns to pharmaceutic companies, and is in and of itself, not synonymous with adverse effects or low efficacy.…”

Section: Discussionmentioning

confidence: 99%

Impact of a national audit on child and adolescent psychiatrists’ prescribing practices

Bond,

Ong,

McNicholas

2024

Ir. j. psychol. Med.

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Background: A look back review of South Kerry Child and Adolescent Mental Health Services (CAMHS) in Ireland, known as the ‘Maskey report’ (MR), highlighted substandard prescribing practices. The aim of this ‘Maskey Impact Study’ (MIS) was to explore changes to child and adolescent psychiatrists’ prescribing practices following the MR. Method: The study was cross-sectional and mixed method. A study specific questionnaire was distributed electronically to psychiatrists working in CAMHS (n = 160). Results: 102 psychiatrists participated in the study (response rate 63.8%). Perceived improvement in prescribing practices included improved medical record keeping (63.7%), consent documentation (53.9%), medication information provision (41.2%) and physical health monitoring (60.8%). However, 43.1% of psychiatrists reported a reluctance to prescribe medication even when clinically indicated and 50% were more likely to avoid off-label use. Most respondents reported increased stress levels (80.4%) with higher stress being significantly associated with reticence in prescribing (χ2 = 11.746, p < .001) and avoiding off-label use (χ2 = 15.392, p < 0.001). Thematic analysis highlighted increased medication hesitancy, enforced ‘meaningless’ bureaucracy and medication mistrust among families. Discussion: Although improvements reported are welcomed, the increased hesitancy of medication use, avoidance of prescribing more than one medication, and avoidance of off-label use, is of concern with potential unintended adverse consequences. Reluctance in prescribing may deprive youth of access to evidence-based treatments and limit exposure of NCHDs to the safe practice of consultant-initiated psychopharmacology. Further research will be important to determine if this impacts clinical care. Continued education in psychopharmacology is essential along with increased public awareness of the evidence for medication, to help restore public confidence and trust in psychopharmacology.

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Section: Discussionmentioning

confidence: 99%

Impact of a national audit on child and adolescent psychiatrists’ prescribing practices

Bond,

Ong,

McNicholas

2024

Ir. j. psychol. Med.

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“…Children with autism spectrum disorder and Down syndrome suffer from an almost twofold incidence of obesity and threefold risk of being diagnosed with NAFLD, due to genetic and environmental factors including the use of medications such as AA, mood stabilizers and selective serotonin reuptake inhibitors SSRIs; ( Shedlock et al, 2016 ). Additionally, high rates of off label prescribing of AA in children and youth occur, particularly to control impulsivity and aggression associated with attention deficit/hyperactivity disorder ADHD; ( Correll and Blader, 2015 ; Sohn et al, 2016 ; Candon et al, 2021 ) and treatment-resistant depression ( Meng et al, 2022 ). As discussed earlier, AA are associated with significant endocrine and metabolic side effects including hyperlipidemia, insulin resistance and weight gain, each of which are associated with the development of NAFLD.…”

Section: Prevalence Of Non-alcoholic Fatty Liver Disease/non-alcoholi...mentioning

confidence: 99%

Non-alcoholic fatty liver disease (NAFLD) and mental illness: Mechanisms linking mood, metabolism and medicines

et al. 2022

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Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world and one of the leading indications for liver transplantation. It is one of the many manifestations of insulin resistance and metabolic syndrome as well as an independent risk factor for cardiovascular disease. There is growing evidence linking the incidence of NAFLD with psychiatric illnesses such as schizophrenia, bipolar disorder and depression mechanistically via genetic, metabolic, inflammatory and environmental factors including smoking and psychiatric medications. Indeed, patients prescribed antipsychotic medications, regardless of diagnosis, have higher incidence of NAFLD than population norms. The mechanistic pharmacology of antipsychotic-associated NAFLD is beginning to emerge. In this review, we aim to discuss the pathophysiology of NAFLD including its risk factors, insulin resistance and systemic inflammation as well as its intersection with psychiatric illnesses.

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