Off-label prescribing in older patients.
The practice of off-label prescribing, i.e. prescribing drugs either for unregistered/unapproved therapeutic indications and age groups or using unregistered/unapproved doses or methods of administration, is common in older patients. This may be due to the poor representation of this group in pre-marketing clinical trials assessing therapeutic efficacy and safety of novel therapies or merely to the fact that trials in a particular indication have not been undertaken. Off-label prescribing should not be viewed as scientifically or ethically unsound when there are good clinical data to support a particular therapeutic indication. However, a number of steps should be followed in order to ensure therapeutic efficacy, reducing, at the same time, the risk of adverse drug reactions and/or medical litigation. This article discusses the current epidemiology and trends in off-label prescribing in older patients, the scientific and ethical justification of this practice, medico-legal implications, and proposed strategies for risk mitigation.
Department of Clinical Gerontology, Kings Health Partners Academic Health Science Centre, London, UK. stephen.jackson@kcl.ac.uk
Stephen H D
SH
Jackson
Paul A F
PA
Jansen
Arduino A
AA
Mangoni
D000367:Age Factors; D000368:Aged; D006801:Humans; D056687:Off-Label Use / Q000941:ethics / Q000706:statistics & numerical data*; D012308:Risk Management