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Off-label and unlicensed prescribing of psychotropics in children in Dutch general practice (2004).

Volkers, A., Dijk, L. van. Off-label and unlicensed prescribing of psychotropics in children in Dutch general practice (2004). European Journal of Public Health: 2006, 16(Suppl. 1) 215-216. Abstract. 14 th Eupha conference "Politics, Policies and /or the Public's Health", Montreux, 16-18 November 2006.
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Background: Unsafe drug use is a point of concern in children with psychotropics. Methylfenidate is licensed to prescribe above the age of 6 years, but most of the antidepressants and benzodiazepines are not approved in children. We studied the off-label and unlicensed prescribing of psychotropics in children in Dutch general practice. Methods: Our data source is The Netherlands Information Network of general practice (LINH). Patients and practices are representative for the Dutch general practice. In 2004, 70 general practices participated this network. GPs recorded diagnoses (ICPC) and prescriptions (ATC) in their practice computer during each patient contact. Among the 97 072 listed patients <18 years we selected those with prescriptions of methylfenidate, antidepressants, and benzodiazepines. Results: The prescription rate of methylfenidate was 3.9 per 1000 patients, of benzodiazepines 2.6 per 1000 patients, and of antidepressants 1.4 per 1000 patients. A total of 4.1% of the methylfenidate prescriptions was prescribed to children <6 years. Methylfenidate prescriptions had the indications overactive child and worries about behaviour of child (ADHD). Twenty-six per cent of all benzodiazepines prescriptions were prescribed to children between 0 and 5 years, 22% to children between 6 and 11 years and 52% to adolescents. Most of them were anxiolytics (83%). The youngest patients used them for convulsions and epilepsy and the oldest patients for anxiety and a variety of other psychic problems. Children <6 years got no antidepressants, while children <12 years used antidepressants for nocturnal enuresis (TCAs) and for ADHD and depression (SSRIs). Children >12 years used them for nocturnal enuresis, anxiety, depression and several other psychic problems (TCAs) and for depression and anxiety (SSRIs and SNRIs). Conclusions: Nearly 1% of the children in general practice got psychotropics. The problem of off-label and unlicensed prescribing was largest in case of benzodiazepines and SSRIs. Insight in clinical and patient characteristics of unsafe drug use is necessary to improve the off-label and unlicensed prescribing of psychotropics in children. (aut. ref.)
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