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Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system

BMJ 2017; 356 doi: (Published 21 February 2017) Cite this as: BMJ 2017;356:j603

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Off-label use and GP's Role

Often when we discuss the off-label use of drugs it is stated that the responsibility for inadequate prescriptions is mainly induced by the general practitioner. Probably GPs prescribe medicines off-label because they are convinced of the positive effect seen in clinical practice, or because they repeat a prescription rom a specialist, or because the patient reports a clinical improvement.

But if there is no scientific evidence in favor of an off-label use of a drug, who leads the off-label use?

We may assume that the pharma companies can cause covertly a positive effect in patients without an indication approved, or off-label use is due to a cultural deficiency.

From an economic standpoint, it would be interesting to test the effect of a new rule that, for every box of medicine prescribed off-label, the manufacturing industry will reimburse the health care system.

Probably, we would witness greater publicity to the information recorded and a high number of continuing medical education events on the appropriate use of drugs.

In addition, it must kept in mind that often the drug off-label has a scientific basis that allows the dentist to resolve many clinical situations.

Just think of the many drugs used in pediatric patients, or the use of NSAIDs administered with low dose intradermally (mesotherapy) instead of high doses of anti-inflammatories administered systemically.

So, from a scientific point of view, it would be interesting to monitor the use of off-label drugs to find out which drug provides scientific research lines to be explored.

Many drugs have been registered for diseases randomly identified during the phases of clinical trials and the GP is - in my opinion - a doctor who experiences every day the effect of prescribing drugs.

Competing interests: No competing interests

27 February 2017
Massimo Mammucari
General Practitioner
Primary Care, ASL RM 1 Rome, Italy
via Aurelia 784, Rome, Italy