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Current Drug Safety

Editor-in-Chief

ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Research Article

Risk Minimization Measures in Off-Label Drug Use: A Survey of Community Pharmacists in Malaysia

Author(s): Omotayo Fatokun*

Volume 15, Issue 3, 2020

Page: [181 - 189] Pages: 9

DOI: 10.2174/1573403X16666200615144946

Price: $65

Abstract

Background: While off-label drug use is common and sometimes necessary, it also presents considerable risks. Therefore, measures intended to prevent or reduce the potential exposure to off-label risks have been recommended. However, little is known about community pharmacists’ beliefs regarding these measures in Malaysia.

Objectives: This study examined community pharmacists’ beliefs towards risk minimization measures in off-label drug use in Malaysia and assessed the relationship between perceived risk of off-label drug use and beliefs towards risk minimization measures.

Methods: A cross-sectional survey was conducted among 154 pharmacists practicing in randomly selected community pharmacies in Kuala Lumpur and the State of Selangor, Malaysia.

Results: The majority agreed or strongly agreed that adverse drug events from the off-label drug should be reported to the regulatory authority (90.9%) and the off-label drug should only be used when the benefit outweighs potential risks (88.3%). Less than half (48.1%) agreed or strongly agreed that written informed consent should be obtained before dispensing off-label drugs and a majority (63.7%) agreed or strongly agreed that the informed consent process will be burdensome to healthcare professionals. Beliefs towards risk minimization measures were significantly associated with perceived risk of off-label drug use regarding efficacy (p = 0. 033), safety (p = 0.001), adverse drug rection (p = 0.001) and medication errors (p = 0.002).

Conclusion: The community pharmacists have positive beliefs towards most of the risk minimization measures. However, beliefs towards written informed consent requirements are not encouraging. Enhancing risk perception may help influence positive beliefs towards risk minimization measures.

Keywords: Off-label, risk minimization, community pharmacists, risk perception, beliefs, Malaysia.

[1]
Gazarian M, Kelly M, McPhee JR, Graudins LV, Ward RL, Campbell TJ. Off-label use of medicines: Consensus recommendations for evaluating appropriateness. Med J Aust 2006; 185(10): 544-8.
[http://dx.doi.org/10.5694/j.1326-5377.2006.tb00689.x] [PMID: 17115966]
[2]
Eguale T, Buckeridge DL, Verma A, et al. Association of off-label drug use and adverse drug events in an adult population. JAMA Intern Med 2016; 176(1): 55-63.
[http://dx.doi.org/10.1001/jamainternmed.2015.6058] [PMID: 26523731]
[3]
European Medicines Agency. Evidence of harm from off-label or unlicensed medicines in children 2004. Available from: https://www.ema.europa.eu/en/documents/other/evidence-harm-label-unlicensed-medicines-children_en.pdf
[4]
Pratico AD, Longo L, Mansueto S, et al. Off-label use of drugs and adverse drug reactions in pediatric units: A prospective, multicenter study. Curr Drug Saf 2018; 13(3): 200-7.
[http://dx.doi.org/10.2174/1574886313666180619120406] [PMID: 29921210]
[5]
Pelegrin GM. Off-label uses of prescription drugs? An overview. Pharmacy Times 2004. Available from: https://www.pharmacytimes.com/publications/issue/2004/2004-03/2004-03-7742
[6]
Health action international. Regulating the off-label drug use of medicines in europe Policy Brief 2018. Available from: http://haiweb.org/wp-content/uploads/2018/10/Off-label-Use-of-Medicines-in-Europe.pdf
[7]
Dresser R, Frader J. Off-label prescribing: a call for heightened professional and government oversight. J Law Med Ethics 2009; 37(3): 476-86.
[http://dx.doi.org/10.1111/j.1748-720X.2009.00408.x] [PMID: 19723258]
[8]
Ventola CL. Off-label drug information: Regulation, distribution, evaluation, and related controversies. P&T 2009; 34(8): 428-40.
[PMID: 20140107]
[9]
Drenska M, Getov I. Research on approaches for regulation of the “off-label” use of medicinal products in the European Union Acta Med Bulg 2017; 44(1): 17-21.
[http://dx.doi.org/10.1515/amb-2017-0003]
[10]
Wilkes M, Johns M. Informed consent and shared decision-making: A requirement to disclose to patients off-label prescriptions. PLoS Med 2008; 5(11)e223
[11]
[12]
Pharmaceutical Services Programme. Consent form for treatment using medicine with unregistered medicine/indication (off label) Selangor: Pharmaceutical Services Programme, Ministry of Health Malaysia 2019. Available from: https://www.pharmacy.gov.my/v2/en/documents/consent-form-treatment-using-unregistered-medicine-indication-label.html
[13]
Balan S, Ahmad Hassali MA, Mak VSL. Attitudes, knowledge and views on off-label prescribing in children among healthcare professionals in Malaysia. Int J Clin Pharm 2019; 41(4): 1074-84.
[http://dx.doi.org/10.1007/s11096-019-00862-y] [PMID: 31197546]
[14]
Ekins-Daukes S, Helms PJ, Taylor MW, McLay JS. Off-label prescribing to children: Attitudes and experience of general practitioners. Br J Clin Pharmacol 2005; 60(2): 145-9.
[http://dx.doi.org/10.1111/j.1365-2125.2005.02397.x] [PMID: 16042667]
[15]
Lee JL, Redzuan AM, Shah NM. Unlicensed and off-label use of medicines in children admitted to the intensive care units of a hospital in Malaysia. Int J Clin Pharm 2013; 35(6): 1025-9.
[http://dx.doi.org/10.1007/s11096-013-9846-0] [PMID: 24022725]
[16]
Mohamad NF, Mhd Ali A, Mohamed Shah N. Respiratory drugs prescribed off-label among children in the outpatient clinics of a hospital in Malaysia. Int J Clin Pharm 2015; 37(1): 127-32.
[http://dx.doi.org/10.1007/s11096-014-0049-0] [PMID: 25488318]
[17]
Tan RW, Mohamed Shah N. Antihistamines prescribed off-label among paediatric patients at a tertiary care hospital setting in Malaysia. Int J Clin Pharm 2016; 38(5): 1277-85.
[http://dx.doi.org/10.1007/s11096-016-0364-8] [PMID: 27480982]
[18]
Department of Statistics Malaysia. Population distribution and basic demographic characteristic report 2010 Putrajaya: Department of statistics, Malaysia 2011. Available from: https://www.dosm.gov.my/v1/index.php?r=column/ctheme&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09&bul_id=MDMxdHZjWTk1SjFzTzNkRXYzcVZjdz09
[19]
Pharmaceutical Services Program. Pharmacy programme statistics selangor: Pharmaceutical services programme, Ministry of health Malaysia 2016. Available from: https://www.pharmacy.gov.my/v2/en/content/pharmacy-programme-statistics-2016.html
[20]
Pharmaceutical services division. Ministry of health Malaysia. List of training premises for Provisional Pharmacy Officers (PRP) selangor: Pharmaceutical services programme, ministry of health Malaysia 2019. Available from: https://www.pharmacy.gov.my/v2/ms/entri/senarai-premis-latihan-pegawai-farmasi-provisional-prp.html
[21]
Raosoft. Sample size calculator 2004. Available from: http://www.raosoft.com/samplesize.html
[22]
Stewart D, Rouf A, Snaith A, Elliott K, Helms PJ, McLay JS. Attitudes and experiences of community pharmacists towards paediatric off-label prescribing: A prospective survey. Br J Clin Pharmacol 2007; 64(1): 90-5.
[http://dx.doi.org/10.1111/j.1365-2125.2007.02865.x] [PMID: 17324238]
[23]
Balan S, Hassali MA, Mak VS. Awareness, knowledge and views of off-label prescribing in children: A systematic review. Br J Clin Pharmacol 2015; 80(6): 1269-80.
[http://dx.doi.org/10.1111/bcp.12750] [PMID: 26314841]
[24]
Wittich CM, Burkle CM, Lanier WL. Ten common questions (and their answers) about off-label drug use. Mayo Clin Proc 2012; 87(10): 982-90.
[http://dx.doi.org/10.1016/j.mayocp.2012.04.017] [PMID: 22877654]
[25]
Stafford RS. Regulating off-label drug use-rethinking the role of the FDA. N Engl J Med 2008; 358(14): 1427-9.
[http://dx.doi.org/10.1056/NEJMp0802107] [PMID: 18385495]
[26]
Dal Pan GJ. Monitoring the safety of medicines used off-label. Clin Pharmacol Ther 2012; 91(5): 787-95.
[http://dx.doi.org/10.1038/clpt.2012.24] [PMID: 22472983]
[27]
Cavalla D. Off-label prescribing: Justifying unapproved medicine. Oxford: Wiley-Blackwell 2015.
[28]
Larizgoitia I, Bouesseau MC, Kelley E. WHO efforts to promote reporting of adverse events and global learning. J Public Health Res 2013; 2(3)e29
[29]
World Health Organization. WHO best-practice statement on the off-label use of bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis Geneva: World Health Organization 2017. Available from: https://apps.who.int/iris/handle/10665/258941
[30]
Rodwin MA. Rooting out institutional corruption to manage inappropriate off-label drug use. J Law Med Ethics 2013; 41(3): 654-64.
[http://dx.doi.org/10.1111/jlme.12075] [PMID: 24088156]
[31]
Ruan X, Kaye AD. Off-label prescribing: Justified or not? Am J Med Qual 2016; 31(2): 101-2.
[http://dx.doi.org/10.1177/1062860615599838] [PMID: 26250929]
[32]
Basak R, McCaffrey DJ III. Hospital pharmacists’ perceived beliefs and responsibilities in indication-based off-label prescribing. Int J Clin Pharm 2018; 40(1): 36-40.
[http://dx.doi.org/10.1007/s11096-017-0567-7] [PMID: 29204800]
[33]
Mukattash TL, Alzoubi KH, Abuirjie AM, et al. Perceptions and attitudes towards off-label dispensing for pediatric patients, a study of hospital based pharmacists in Jordan. Saudi Pharm J 2018; 26(1): 20-4.
[http://dx.doi.org/10.1016/j.jsps.2017.11.004] [PMID: 29379329]
[34]
Mukattash T, Hawwa AF, Trew K, McElnay JC. Healthcare professional experiences and attitudes on unlicensed/off-label paediatric prescribing and paediatric clinical trials. Eur J Clin Pharmacol 2011; 67(5): 449-61.
[http://dx.doi.org/10.1007/s00228-010-0978-z] [PMID: 21243345]
[35]
Vertinsky HB, Wehrung DA. Risk perception and drug safety evaluation 1991. Available from: https://scholars.unh.edu/cgi/viewcontent.cgi?article=1062&context=risk

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