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Original papers: Richard Hodgson and Ravindra Belgamwar Off-label prescribing by psychiatrists Psychiatr Bull 2006; 30: 55-57 [Abstract] [Full text] [PDF]

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Off label prescribing by child and adolescent psychiatrists

Anne Thompson, Manash Chattopadhyay   (14 July 2006)

Off label prescribing by child and adolescent psychiatrists 14 July 2006
Anne Thompson, Consultant Psychiatrist MB BS, MRCP(UK), MRCPsych, Lincolnshire Partnership NHS Trust, Manash Chattopadhyay Send letter to journal: Re: Off label prescribing by child and adolescent psychiatrists anne.thompson{at}lpt.nhs.uk Anne Thompson, et al.	We read with interest Hodgson and Belgamwar’s account of off-label prescribing by psychiatrists (Hodgson and Belgamwar, 2006). Children under 16 were not apparently included in the survey. If they had been, we suggest that more prescribing of atypical antipsychotic medication for unlicensed applications would have been revealed. A growing number of UK child and adolescent psychiatrists are prescribing psychoactive drugs. Atypical antipsychotic medication, most commonly risperidone, is prescribed to children to help in the management of severe aggression complicating autistic spectrum disorder (Volkmar et al, 2004), treatment resistant ADHD and aggression associated with disruptive behaviour disorders (Taylor et al, 2004). Risperidone is not licensed for any of these indications, but can be effective. Even when being used for the treatment of early onset schizophrenia, risperidone is not licensed for use in children less than 15 years of age. Child and adolescent psychiatrists are used to having to use most psychoactive medications off-label. In fact many drugs given to children to treat all manner of medical, surgical and mental health conditions do not have a product license for use in this age group: over two thirds of children admitted to wards in five European hospitals received drugs prescribed in an unlicensed or off-label manner (Conroy et al ,2000). We agree with Hodgson and Belgamwar that issues of informed consent are very important in off-label prescribing. A policy statement and patient information leaflets are available to support off-label prescribing for children (Royal College of Paediatrics and Child Health, 2000). In the absence of an established evidence base for using a drug for an unlicensed application, prescribers should look to keep their practice in line with their peers. The national network of paediatric psychopharmacology special interest groups are one source of peer group supervision and support for child & adolescent psychiatrists. Although in any one health district, the economic impact of a few children being prescribed atypical antipsychotic medication at any one time will be small, the clinical and governance implications of this practice need to be recognized by Trusts and commissioners. Yours sincerely Dr Anne Thompson MB BS MRCP (UK) MRCPsych Consultant Child & Adolescent Psychiatrist Dr Manash Chattopadhyay MB BS MRCPsych Senior House Officer in Psychiatry Declaration of interest : None References Conroy, S., Choonara, I., Impicciatore, P., et al (2000) Survey of unlicensed and off label drug use in paediatric wards in European countries. British Medical Journal, 320, 79–82. Hodgson, R., & Belgamwar, R. (2006) Off- label prescribing by psychiatrists. Psychiatric Bulletin, 30, 55-57. Royal College of Paediatrics and Child Health (2000) The use of unlicensed medicines or licensed medicines for unlicensed applications in paediatric practice : Policy statement produced by the joint RCPCH/NPPG standing committee on medicines. London : Royal College of Paediatrics and Child Health. Taylor, E., Dopfner, M., Sergeant, J., et al (2004) European clinical guidelines for hyperkinetic disorder – first upgrade. European Child And Adolescent Psychiatry, 13, Supplement 1. Volkmar, F. R., Lord, C., Bailey, A., et al (2004) Autism and pervasive developmental disorder. Journal of Child Psychology and Psychiatry, 45, 135-170.