Off-label use of antipsychotics and associated factors in community living older adults^*

* This research was conducted at the Charles-Le Moyne Hospital Research Center², Quebec, Canada.

ABSTRACT

Background: Given the common off-label use of antipsychotics (AP), we aimed to assess the factors associated with this use in community living older adults.

Methods: The study sample consisted of a large representative sample of older adults (n = 4108), covered under a public drug insurance plan in Canada. Off-label use of antipsychotics was defined by the absence of an approved indication for this use, according to Health Canada's drug product database. Multinomial logistic regression was used to assess the factors associated with off-label use.

Results: The prevalence of antipsychotics use was 2.5%, of which 78% was off-label. Compared to non-use, off-label antipsychotics use was negatively associated with advanced age (≥75 vs. 65–74 years old) (OR: 0.46; 95%CI: 0.27–0.78); and positively associated with higher education level (OR: 2.68; 95% CI: 1.64–4.40), higher number of outpatient visits (≥6) (OR: 2.39; 95%CI: 1.34–4.25), antidepressant or benzodiazepine use (OR: 5.81; 95%CI: 3.31–10.21), and the presence of an organic brain syndrome & Alzheimer's (OR: 5.73; 95%CI: 1.74–18.89). Compared to labeled use, off-label use was less likely in those with major depression (OR: 0.02; 95%CI: <0.01–0.11) and with insomnia (OR: 0.13; 95%CI: 0.02–0.91).

Conclusions: The majority of antipsychotics prescribed to community living older adults were off-label. This off-label use was more likely in complex clinical cases with multiple outpatient visits and other psychotropic drugs use. Further research should focus on the long-term effects associated with off-label use of antipsychotics.

KEYWORDS:

• Antipsychotics
• off-label use
• older adults
• prevalence

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The ESA study was supported by the Canadian Institute of Health Research (CIHR)’ operating [grant number 200403MOP] and a Quebec Health Research fund—Fonds de Recherche Quebec—Santé (FRQS) [grant number 9854], [grant number 22251]. H. Bakouni holds an MSc scholarship from the HCLM [hopital Chales-Lemoyne] research center and bank TD. Dr Vasiliadis is a senior research scholar with the FRQ-S.