Objective: Guidance on pharmacotherapy of neurobehavioural sequelae post-acquired brain injury (ABI) is limited. Clinicians face the choice of prescribing off-label. This survey assesses prescribing practice and off-label use of psychotropic medications in Italian brain injury rehabilitation centres and factors associated with atypical antipsychotics use. Materials and methods: Centres were identified through the roster of the Italian Society for Rehabilitation Medicine. Information was collected through a structured questionnaire. This study calculated the prevalence of centres reporting to use off-label individual medications and unconditional logistic regression Odds Ratio (OR), with 95% confidence interval (95% CI) of atypical antipsychotics use. Results: Psychotropic medications were commonly used. More than 50% of the 35 centres (participation ratio 87.5%) reported to use off-label selected antipsychotics, mostly for agitation (90.5%) and behavioural disturbances (19.0%), and antidepressants, mostly for insomnia (37.5%) and pain (25.0%). Atypical antipsychotic use was directly associated with age <40 years (OR=2.68; 95% CI=1.25-5.76), recent ABI (1.74; 0.74-4.09), not with reported off-label use (0.98; 0.44-2.18). Conclusion: In clinical practice, the effectiveness and safety of medications, in particular off-label, should be systematically monitored. Studies are needed to improve the quality of evidence guiding pharmacotherapy and to evaluate effectiveness and safety of off-label prescribing.

Prescribing practice and off-label use of psychotropic medications in post-acute brain injury rehabilitation centres: A cross-sectional survey

BASAGLIA, Nino;
2015

Abstract

Objective: Guidance on pharmacotherapy of neurobehavioural sequelae post-acquired brain injury (ABI) is limited. Clinicians face the choice of prescribing off-label. This survey assesses prescribing practice and off-label use of psychotropic medications in Italian brain injury rehabilitation centres and factors associated with atypical antipsychotics use. Materials and methods: Centres were identified through the roster of the Italian Society for Rehabilitation Medicine. Information was collected through a structured questionnaire. This study calculated the prevalence of centres reporting to use off-label individual medications and unconditional logistic regression Odds Ratio (OR), with 95% confidence interval (95% CI) of atypical antipsychotics use. Results: Psychotropic medications were commonly used. More than 50% of the 35 centres (participation ratio 87.5%) reported to use off-label selected antipsychotics, mostly for agitation (90.5%) and behavioural disturbances (19.0%), and antidepressants, mostly for insomnia (37.5%) and pain (25.0%). Atypical antipsychotic use was directly associated with age <40 years (OR=2.68; 95% CI=1.25-5.76), recent ABI (1.74; 0.74-4.09), not with reported off-label use (0.98; 0.44-2.18). Conclusion: In clinical practice, the effectiveness and safety of medications, in particular off-label, should be systematically monitored. Studies are needed to improve the quality of evidence guiding pharmacotherapy and to evaluate effectiveness and safety of off-label prescribing.
2015
Pisa, Federica Edith; Cosano, Giorgia; Giangreco, Manuela; Giorgini, Tullio; Biasutti, Emanuele; Barbone, Fabio; Formisano, R.; Buzzi, M. G.; Pistarini, C.; Aiachini, B.; Basaglia, Nino; Montis, A.; Lucca, L. F.; Lombardi, F.; Ranza, E.; Vallasciani, M.; Celentano, A.; Naldi, A.; Castellani, G.; Lamberti, G.; Lanzillo, B.; Posteraro, F.; Logi, F.; Molteni, F.; Lanfranchi, M.; Gramigna, C.; Bertagnoni, G.; Dell'Oste, P.; Tonin, P.; Iaia, V.; Posteraro, F.; Sagliocco, L.; Beatrici, M.; Giunta, N.; Dore, T.; Galardi, G.; Sant'Angelo, N.; Piperno, R.; Battistini, A.; Zampolini, M.; Scarponi, F.; Sanna, V.; Biella, A. M.; Premoselli, S.; Zaro, F.; Bernasconi, K.; Carnovali, M.; Chierici, S.; Antenucci, R.; Salvi, G. P.; Mazzini, N.; Ventura, F.; Lonati, M. C.; Brianti, R.; Mammi, P.; Molinero, G.; De Tanti, A.; Bertolino, C.; Boldrini, P.; Bargellesi, S.; Boldrini, P.; Tessari, A.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2341562
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