Awareness, Practice, and Views of Pediatricians, General Physicians, and Pharmacists about Prescribing Off-label Medication in Pediatric Patients
in Eastern Province, Saudi Arabia
Authors: Almintakh Layan Sameer , Al Dossary Mariam Fahad , Altesha Abrar Mohmmadjamal , Alqahtani Rayanah Fahad , Alsomali Samiah Mohammad , Banu Nuzhat , Ali Mohammad Daud , Ahmed Ayaz 
Published: June 2024

Background:
An off-label medication involves the use of an approved drug for an unapproved
indication, population, route of administration, or dosage.The physiological state of children
differs from that of adults, making the adult formulation potentially dangerous to children.
Off-label prescribing is quite common in children due to challenges in the development of pediatric
formulations. The current study was conducted to determine the awareness, practice, and
views of pediatricians, general physicians, and pharmacists about prescribing Off-label medication
to pediatric patients in Eastern Province, Saudi Arabia.

Methods:
A cross-sectional study based on a questionnaire was conducted among pediatricians,
general physicians, and pharmacists (clinical and community) in Eastern Province, Saudi Arabia.
Statistical analysis was conducted using the data exported from Google Forms (Mountain View,
California, USA) and Microsoft Excel (Version 2016) and then exported into Statistical Package
for Social Sciences (SPSS) version 26.0 (IBM, Inc., Armonk, NY, USA). Chi-square was deemed
suitable. The level of significance was set at 0.05.

Results:
Among the study participants, 53(35.09%) were pharmacists, followed by 24(15.89%)
others, 22(14.565) pediatricians, 19(12.58%) other specialists, 17(11.25%) general physicians,
and 16(10.59%) were clinical pharmacist. About 73(48.34%) described the definition of off-label
correctly. About 114(75.49%) believed that parents and guardians must be informed about off-label
medicine prescribed to their children. About 52(34.43%) had concerns about the safety of the
medication, and 98(64.90%) believed they should be tested in pediatrics during clinical trials. Further,
97(64.23%) considered themselves not enough knowledgeable about off-label medications.
The barriers reported by the participants were as follows: 89(58.945%) said lack of information resources,
71(47.01%) said lack of training, 56(37.08%) said lack of information on the safety of excipients
used in pediatrics, 47(31.12%) said lack of formulary, 44(29.13%) said lack of guidelines,
and 58(5.29%) said lack of information related to the safety of excipient concentration in pediatrics.
The proportion of healthcare professionals who agreed that excipients in adult medication
may be harmful to pediatrics was 103(68.21%). The drugs most often prescribed as off-label were
paracetamol 54(21.68%), followed by Phenobarbital 35(14%), and Amoxicillin 33(13.25%).

Conclusion:
There are a considerable number of healthcare professionals unaware of the description
of off-label medication. The majority have concerns over the safety and efficacy of the off-label
drugs and believe that most frequently used off-label drugs in pediatrics must be tested in pediatrics
during clinical trials. In addition, excipient safety data are of considerable importance to ensure
off-label drug safety in pediatrics, who believe their knowledge is inadequate and need proper
guidelines and training on this issue.

result:
Among the study participants, 53[35.09%] were pharmacists, followed by 24[15.89%] others, 22[14.565] pediatricians, 19[12.58%] other specialists, 17[11.255] general physicians, and 16[10.59%] were clinical pharmacist.73[48.345] described the definition of off-label correctly.114[75.495] believe that parents and guardians must be informed about off-label medicine prescribed to their children. 52[34.43%] had concerns about the safety of the medication and 98[64.90%] believed they should be tested in paediatrics during clinical trials.97[64.23%] consider themselves not enough knowledgeable about off-label medications. The barriers reported were 89[58.945] said lack of information resources, 71[47.01%], lack of training, 56[37.085] lack of information on the safety of excipients used in paediatrics, 47[31.12%] lack of formulary,44[29.13%] lack of guidelines, 58[5.29%] said lack of information related to the safety of excipient concentration in paediatrics. The proportion of healthcare professionals who agreed that excipients in adult medication may be harmful to paediatrics was 103[68.21%]. The drugs most often prescribed as off-label were paracetamol 54[21.68%], followed by Phenobarbital 35[14%], and Amoxicillin 33[13.25%].