The maverick practice of off-label prescribing - giving drugs for unapproved conditions/patients - is once again in the limelight. The US Food and Drug Administration (FDA) has issued a warning against using ‘atypical antipsychotics’ to treat behavioural disorders in elderly patients after 15 clinical trials showed that older patients with dementia, treated with either olanzapine, aripiprazole, risperidone or quetiapine, were nearly twice as likely to die compared with those given a placebo. The specific causes of death were mainly heart-related events (for example, heart failure or sudden death) or infections (mostly pneumonia). This class of drugs is only approved for schizophrenia (www.fda.gov/cder/drug/advisory/antipsychotics.htm).
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