Psychiatric Bulletin (2007) 31: 275. doi: 10.1192/pb.bp.107.015370
© 2007 The Royal College of Psychiatrists
Use of licensed medicines for unlicensed applications in psychiatric practice
College Report CR142, January 2007, Royal College of Psychiatrists £7.50, 32 pp
Drug treatment is an essential part of much of psychiatric practice in
patients from a wide age range and across many diagnostic groups. Despite the
availability of many classes of psychotropic drugs, a substantial proportion
of patients will remain troubled by persistent, distressing and impairing
symptoms, even after a succession of licensed pharmacological treatments. In
this situation, many psychiatrists will consider the prescription of
psychotropic drugs outside the narrow terms of their licence, as part of an
overall plan of management.
As this aspect of clinical practice in psychiatry has recently come under
some scrutiny, a working group of the Special Interest Group in
Psychopharmacology (SIGP) of the Royal College of Psychiatrists was convened
to examine the nature and extent of the use of licensed psychotropic drugs for
unlicensed applications in psychiatric practice, to consider any potential
benefits and risks associated with this aspect of clinical practice, to
outline when this may be an appropriate part of the management of individual
patients, and to make balanced recommendations for a suggested procedure when
prescribing licensed medication for unlicensed applications.
This College Report summarises the discussions and conclusions of the
working group, and incorporates feedback from the wider membership of the
SIGP. It is recommended that unlicensed prescribing should only occur when
licensed treatments have been used or excluded on clinical grounds; and when
the prescriber is familiar with any possible benefits and risks of the
medication being considered, and feels confident with the proposed treatment.
Whenever possible the agreement of the patient should be obtained; but if not
possible, this should be noted. Prescriptions should be started cautiously,
and the subsequent progress of the patient should be monitored closely. If the
treatment proves ineffective it should be withdrawn carefully and if
effective, the patient should be reviewed regularly. This aspect of
prescribing practice may be a suitable area for review within continuous
professional development peer groups and for clinical audit within mental
health services.
