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. 2000 Dec;83(6):502–505. doi: 10.1136/adc.83.6.502

Off label and unlicensed drug use among French office based paediatricians

M Chalumeau 1, J Treluyer 1, B Salanave 1, R Assathiany 1, G Cheron 1, N Crocheton 1, C Rougeron 1, M Mares 1, G Breart 1, G Pons 1
PMCID: PMC1718582  PMID: 11087286

Abstract

AIMS—To determine the extent of off label and unlicensed drug use in French office based paediatric practice.
METHODS—A prospective one day survey of all written prescriptions, for patients under 15 years, among 95 office based paediatricians in the Paris, France metropolitan area. Main outcome measures were: comparison of the use of each drug with its product licence for age, indication, dose, and route of administration.
RESULTS—A total of 2522 prescriptions were administered to 989 patients; 844 (33%) were used either in an unlicensed (4%) or an off label (29%) manner. A total of 550 (56%) paediatric patients received one or more off label prescriptions.
CONCLUSIONS—Off label prescriptions (that is, outside the terms of the Summary of Product Characteristics) are widespread in office based paediatric practice, while unlicensed drug use is rare in our study. New regulations in the licensing process in Europe are needed to allow children to receive drugs that have been fully evaluated in their specific age group.



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Selected References

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  1. Avenel S., Bomkratz A., Dassieu G., Janaud J. C., Danan C. Incidence des prescriptions hors autorisation de mise sur le marché en réanimation néonatale. Arch Pediatr. 2000 Feb;7(2):143–147. doi: 10.1016/s0929-693x(00)88083-5. [DOI] [PubMed] [Google Scholar]
  2. Bonati M., Choonara I., Hoppu K., Pons G., Seyberth H. Closing the gap in drug therapy. Lancet. 1999 May 8;353(9164):1625–1625. doi: 10.1016/S0140-6736(05)75752-4. [DOI] [PubMed] [Google Scholar]
  3. Chalumeau M., Salanave B., Assathiany R., Kemeny J., Breart G. Connaissance et application par des pédiatres de ville de la conférence de consensus sur les rhinopharyngites aiguës de l'enfant. Groupe AREPEGE. Arch Pediatr. 2000 May;7(5):481–488. doi: 10.1016/s0929-693x(00)89003-x. [DOI] [PubMed] [Google Scholar]
  4. Choonara I., Dunne J. Licensing of medicines. Arch Dis Child. 1998 May;78(5):402–403. doi: 10.1136/adc.78.5.402. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Collier J. Paediatric prescribing: using unlicensed drugs and medicines outside their licensed indications. Br J Clin Pharmacol. 1999 Jul;48(1):5–8. doi: 10.1046/j.1365-2125.1999.00983.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Conroy S., Choonara I., Impicciatore P., Mohn A., Arnell H., Rane A., Knoeppel C., Seyberth H., Pandolfini C., Raffaelli M. P. Survey of unlicensed and off label drug use in paediatric wards in European countries. European Network for Drug Investigation in Children. BMJ. 2000 Jan 8;320(7227):79–82. doi: 10.1136/bmj.320.7227.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Conroy S., McIntyre J., Choonara I. Unlicensed and off label drug use in neonates. Arch Dis Child Fetal Neonatal Ed. 1999 Mar;80(2):F142–F145. doi: 10.1136/fn.80.2.f142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Donovan L. Why us? Why me? Arch Dis Child. 2000 Oct;83(4):297–297. doi: 10.1136/adc.83.4.297. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Gupta A., Waldhauser L. K. Adverse drug reactions from birth to early childhood. Pediatr Clin North Am. 1997 Feb;44(1):79–92. doi: 10.1016/s0031-3955(05)70464-8. [DOI] [PubMed] [Google Scholar]
  10. Hodson E. M., Knight J. F., Willis N. S., Craig J. C. Corticosteroid therapy in nephrotic syndrome: a meta-analysis of randomised controlled trials. Arch Dis Child. 2000 Jul;83(1):45–51. doi: 10.1136/adc.83.1.45. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Impicciatore P., Choonara I. Status of new medicines approved by the European Medicines Evaluation Agency regarding paediatric use. Br J Clin Pharmacol. 1999 Jul;48(1):15–18. doi: 10.1046/j.1365-2125.1999.00981.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kauffman R. E. Status of drug approval processes and regulation of medications for children. Curr Opin Pediatr. 1995 Apr;7(2):195–198. doi: 10.1097/00008480-199504000-00014. [DOI] [PubMed] [Google Scholar]
  13. Kearns G. L., Reed M. D. Immediate action needed to improve labeling of prescription drugs for pediatric patients. Ann Pharmacother. 1997 Feb;31(2):249–251. doi: 10.1177/106002809703100220. [DOI] [PubMed] [Google Scholar]
  14. Martin R. M., Wilton L. V., Mann R. D., Steventon P., Hilton S. R. Unlicensed and off label drug use for paediatric patients. General practitioners prescribe SSRIs to children off label. BMJ. 1998 Jul 18;317(7152):204–204. [PMC free article] [PubMed] [Google Scholar]
  15. McKinzie J. P., Wright S. W., Wrenn K. D. Pediatric drug therapy in the emergency department: does it meet FDA-approved prescribing guidelines? Am J Emerg Med. 1997 Mar;15(2):118–121. doi: 10.1016/s0735-6757(97)90079-6. [DOI] [PubMed] [Google Scholar]
  16. Nahata M. C. Need for conducting research on medications unlabeled for use in pediatric patients. Ann Pharmacother. 1994 Sep;28(9):1103–1104. doi: 10.1177/106002809402800917. [DOI] [PubMed] [Google Scholar]
  17. Partsch C. J., Aukamp M., Sippell W. G. Scrotal temperature is increased in disposable plastic lined nappies. Arch Dis Child. 2000 Oct;83(4):364–368. doi: 10.1136/adc.83.4.364. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Sahid El-Radhi A., Hogg C. L., Bungre J. K., Bush A., Corrigan C. J. Effect of oral glucocorticoid treatment on serum inflammatory markers in acute asthma. Arch Dis Child. 2000 Aug;83(2):158–162. doi: 10.1136/adc.83.2.158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Sutcliffe A. G. Prescribing medicines for children. BMJ. 1999 Jul 10;319(7202):70–71. doi: 10.1136/bmj.319.7202.70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Thompson D. F., Heflin N. R. Frequency and appropriateness of drug prescribing for unlabeled uses in pediatric patients. Am J Hosp Pharm. 1987 Apr;44(4):792–794. [PubMed] [Google Scholar]
  21. Turner S., Gill A., Nunn T., Hewitt B., Choonara I. Use of "off-label" and unlicensed drugs in paediatric intensive care unit. Lancet. 1996 Feb 24;347(9000):549–550. [PubMed] [Google Scholar]
  22. Turner S., Longworth A., Nunn A. J., Choonara I. Unlicensed and off label drug use in paediatric wards: prospective study. BMJ. 1998 Jan 31;316(7128):343–345. doi: 10.1136/bmj.316.7128.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Turner S., Nunn A. J., Fielding K., Choonara I. Adverse drug reactions to unlicensed and off-label drugs on paediatric wards: a prospective study. Acta Paediatr. 1999 Sep;88(9):965–968. doi: 10.1080/08035259950168469. [DOI] [PubMed] [Google Scholar]
  24. Wilton L. V., Pearce G., Mann R. D. The use of newly marketed drugs in children and adolescents prescribed in general practice. Pharmacoepidemiol Drug Saf. 1999 Apr;8 (Suppl 1):S37–S45. doi: 10.1002/(sici)1099-1557(199904)8:1+<s37::aid-pds400>3.3.co;2-0. [DOI] [PubMed] [Google Scholar]

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