International Journal of Clinical Pharmacy

, Volume 39, Issue 4, pp 860–866 | Cite as

Unlicensed and off-label use of drugs in pediatric surgical units at tertiary care hospitals of Pakistan

  • Muhammad Aamir
  • Jamshaid Ali KhanEmail author
  • Faisal Shakeel
  • Syed Muhammad Asim
Research Article


Background Unlicensed and off-label prescribing practice is global dilemma around the world. This pioneering study was designed to determine unlicensed and off-label use of drug in surgical wards of tertiary care hospitals of Pakistan. Objective To assess unlicensed and off-label use of drugs in pediatric surgical unit at three tertiary care hospitals in Peshawar, Pakistan. Setting Two government and one private tertiary care hospitals in Pakistan. Method Drug profiles of 895 patients from three different clinical settings were evaluated for unlicensed and off-label use of drugs using Micromedex DRUGDEX. Main outcome measure Characteristics of the unlicensed and off-label drug prescriptions. Result Total of 3168 prescribed drugs were analyzed in this study. Indication (38.7%) and dose (34.8%) were the most frequent off-label categories. In comparison with the corresponding reference categories, infants and children, male patients and having less than five prescribed drugs were significant predictors of unlicensed prescriptions. In comparison with the corresponding reference categories, significant predictors of off-label drug prescribing were children younger than two year, children between 2–12 years, patient staying at hospital less than 5 days and patients having less than five prescribed drugs. Conclusion The prevalence of unlicensed and off-label drug prescriptions are high at pediatric surgical ward of tertiary care hospitals. More awareness of the efficacy and safety of drugs are required in pediatrics. In addition, new formulations with advanced dosing for children are also required to minimize the risk of adverse outcomes.


Off-label medicine use Pakistan Pediatrics Unlicensed medicines 



Special thanks to the Directorate of Science and Technology, Khyber Pakhtunkhwa, for their support through the provision of Micromedex DRUGDEX database.



Conflicts of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  1. 1.Department of PharmacyUniversity of PeshawarPeshawarPakistan
  2. 2.Department of PharmacySarhad University of Science and Information TechnologyPeshawarPakistan
  3. 3.Department of StatisticsUniversity of PeshawarPeshawarPakistan

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