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Antipsychotic off-label use in the 21st century: An enduring public health concern

Hélène Verdoux1

  • 1University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France.

Dialogues in Clinical Neuroscience
|January 10, 2025
PubMed

Insights

Antipsychotic off-label use (OLU) remains high in youth and adults, often for anxiety or sleep. Monitoring OLU is crucial due to potential adverse drug reactions (ADR) and industry influence.

Area of Science:

  • Psychiatry
  • Pharmacology
  • Public Health

Background:

  • Off-label use (OLU) of antipsychotics has become common since the introduction of second-generation agents.
  • Monitoring antipsychotic OLU is essential due to increasing patient exposure and potential adverse effects.

Purpose of the Study:

  • To synthesize literature from the past 15 years on antipsychotic OLU for mental health symptoms.
  • To assess the prevalence, drivers, and implications of antipsychotic OLU.

Main Methods:

  • Systematic review of observational studies published over the last 15 years.
  • Analysis of prescribing patterns and influencing factors for antipsychotic OLU.

Main Results:

  • High rates of antipsychotic OLU persist: two out of three youths and 30-60% of adults prescribed antipsychotics use them off-label.
  • Low-dose quetiapine for anxiety/sleep exemplifies a public health concern, driven by marketing and perceived low risk.
  • Antipsychotic OLU may be necessary for resistant disorders but carries risks of adverse drug reactions (ADR).

Conclusions:

  • Antipsychotic OLU is a complex issue requiring careful consideration, balancing potential benefits against risks.
  • Reducing the impact of OLU necessitates controlling pharmaceutical industry influence and improving prescriber/patient education on OLU risks.
  • Further research and guidelines are needed to optimize antipsychotic prescribing practices.
Keywords:
Antipsychoticmarketingmetabolicoff-label use

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