Agency News and Notes

Off-label use of atypical antipsychotics not supported by evidence for some conditions

There is little evidence to support the use of atypical antipsychotic drugs for some treatments other than their officially approved purposes, even though many clinicians continue to commonly prescribe these drugs for so-called "off label" uses, according to a new report from the Effective Health Care Program of the Agency for Healthcare Research and Quality (AHRQ). Atypical antipsychotic medications, which are approved by the U.S. Food and Drug Administration for treatment of schizophrenia, bipolar disorder and, in some cases, depression, are commonly prescribed to treat other behavioral conditions. The report, which is an update of a 2007 report, found limited evidence to support the off-label use of certain atypical antipsychotic medications. Evidence was strongest, for example, for the off-label use of risperidone, olanzapine, and aripiprazole to treat symptoms of dementia; quetiapine to treat generalized anxiety disorder; and risperidone to treat obsessive-compulsive disorder.
However, evidence was lacking to justify the use of these and other atypical antipsychotic drugs to treat substance abuse problems, eating disorders, or insomnia. Atypical antipsychotic medications have been linked to some harms, including a small increased risk of death in elderly patients with dementia, the report said. Off-Label Use of Atypical Antipsychotics: An Update found further research is needed on the efficacy, effectiveness, and harms of off-label use of atypical antipsychotics to determine which population subsets, stratified by age, gender, or race, could benefit from such treatment. Additional research examining differing medication dosages within populations and treatment length will also better guide clinician prescribing practice. You can read and download the full review and other publications from AHRQ’s Effective Health Care Program Web site, http://www.effectivehealthcare.ahrq.gov/.

Research Activities, November 2011: Agency News and Notes: Off-label use of atypical antipsychotics not supported by evidence for some conditions