Off‐label drug use in neonates and infants in Spain: A five‐year observational study

• Published in: Pharmacoepidemiology and drug safety 2022-03, Vol.31 (3), p.270-282
• Main Authors: Lizano‐Díez, Irene, Kargodorian, Joseph, Piñero‐López, M. Ángeles, Lastra, Cecilia F., Mariño, Eduardo L., Modamio, Pilar
• Format: Article
• Language: English
• Subjects: Age groups; Dosage; drug prescription; Health care; Humans; Infant; Infant, Newborn; Infants; Labeling; Neonates; Observational studies; Off-Label Use - statistics & numerical data; off‐label use; outpatient; Prescription drugs; primary health care; Public health; Salbutamol; Spain; Tobramycin
• ISSN: 1053-8569; 1099-1557
• DOI: 10.1002/pds.5354

Objectives To provide information about the off‐label rate of all drug prescriptions in neonates and infants up to 1 year in Spain. Also, to analyse the off‐label prescription of medicines under current practice in this age group according to different evidence sources. Study design A five‐year (2015–2019) exploratory observational study about off‐label prescription in neonates and infants (0 to 1 year) at primary health care in Spain. All drug prescriptions in this age group were analysed and classified according to their labelling in off‐label or on‐label. The drugs prescribed off‐label were subsequently reviewed in national formularies and other databases to assess its evidence of use beyond what is recommended in the Summary of Product Characteristics (SmPC). Results On average 34.50% of total prescriptions were prescribed off‐label according to the SmPC. 17.93% of total prescriptions in neonates and infants up to 1 year old were not based on clinical evidence from SmPC, Pediamécum, BNF or DailyMed. In more than 88% of cases, off‐label use was related to the posology section of the SmPC, followed by the therapeutic indications and contraindications sections, in 35.20% and 24.10% of cases, respectively. Almost 13% of off‐label drugs were over‐the‐counter. Salbutamol followed by topical tobramycin and colecalciferol were the drugs most prescribed off‐label. Conclusions Off‐label use of drugs remains as an important public health concern, especially for neonates and infants up to 1 year, who receive the greatest proportion of off‐label prescriptions. The evidence‐based off‐label prescription is a widespread practice that has shown a stable trend during the 5‐year study period providing also a certain extent of flexibility to paediatricians in some therapeutic decisions.