MANAGED CARE April 2007. ©MediMedia USA
Nearly 4 out of 5 hospitalized children receive medications that have been tested and approved only in adults, according to a study in the Archives of Pediatric and Adolescent Medicine. Pediatric Health Information Systems Research Group performed the study in 31 tertiary hospitals. The adult-approved drugs most prescribed for children were central or autonomic nervous system drugs (specifically morphine), anti-infective agents, and fluids and electrolytes, says the principal investigator, Anthony D. Slonim, MD, of Children's National Medical Center in Washington D.C. "If 80 percent of hospitalized kids at academic pediatric hospitals use drugs off label, then that's a significant amount," says Slonim. Much more study is needed, researchers add.
Medications most often prescribed off-label to children
Morphine
Midazolam
Nystatin
Bacitracin
Dopamine
Nitroprusside
Potassium chloride
Fat emulsions
Methylprednisolone
Fluticasone propionate
Human albumin
Thrombin
Diphenhydramine
Ipratropium bromide
Spironolactone
Povidine-iodine
Central and autonomic central nervous system drugs
Anti-infective agents
Cardiac and adrenergic agents
Fluids, nutrients, and GI agents
Endocrine and metabolic agents
Hematologic, biologic, and immunologic agents
Respiratory tract, and eye, ear, nose, and throat agents
Other agents
Percentage of discharged patients who received the drug
Percentage of patients who received the drug off label
Source: Shah SS, et al. Off-label drug use in hospitalized children. Arch Pediatr Adolesc Med. 2007;161:282–290.