Off-label use of gastrointestinal medications in the intensive care unit

Jeffrey F. Barletta, Ishaq Lat, Scott T. Micek, Henry Cohen, Keith M. Olsen, Curtis E. Haas

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Purpose: Determine the level of evidence supporting off-label gastrointestinal (GI) medication use and identify the medication class and indication whereby off-label use was most common. Materials and Methods: This prospective, multicentered observational study evaluated all medication orders written in 37 intensive care units (ICUs) in the United States, over a 24-hour period. All medications classified as ''GI'' according to a national reference were identified. The class and indication whereby offlabel use was most prominent were determined and the level of evidence was described. Results: There were 774 orders from 363 patients and 63% (489 of 774) were considered off-label. Proton pump inhibitors (PPIs) accounted for most of the off-label usage (55% [271 of 489]), followed by laxatives (16% [77 of 489]) and histamine-2-receptor antagonists (H2RAs; 15% [71 of 489]). When prescribed, 99% (271 of 274) of PPIs, 99% (71 of 72) of H2RAs, and 79% (30 of 38) of promotility agents were off-label. Stress ulcer prophylaxis (100% [309 of 309]), GI bleeding (100% [18 of 18]), and gastric motility (88% [30 of 34]) were the most common off-label indications. The most common strength of recommendation and level of evidence for off-label use was indeterminate (58% [282 of 489]) and none (57% [280 of 489]), respectively. Conclusion: The PPIs are the most widely used off-label medications in the ICU. Stress ulcer prophylaxis is the most common indication. The level of evidence supporting off-label GI medication use is poor.

Original languageEnglish (US)
Pages (from-to)217-225
Number of pages9
JournalJournal of Intensive Care Medicine
Volume30
Issue number4
DOIs
StatePublished - May 8 2015

Fingerprint

Off-Label Use
Proton Pump Inhibitors
Intensive Care Units
Ulcer
Histamine Receptors
Laxatives
Observational Studies
Stomach
Hemorrhage

Keywords

  • gastrointestinal
  • intensive care unit
  • off-label

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Barletta, J. F., Lat, I., Micek, S. T., Cohen, H., Olsen, K. M., & Haas, C. E. (2015). Off-label use of gastrointestinal medications in the intensive care unit. Journal of Intensive Care Medicine, 30(4), 217-225. https://doi.org/10.1177/0885066613516574

Off-label use of gastrointestinal medications in the intensive care unit. / Barletta, Jeffrey F.; Lat, Ishaq; Micek, Scott T.; Cohen, Henry; Olsen, Keith M.; Haas, Curtis E.

In: Journal of Intensive Care Medicine, Vol. 30, No. 4, 08.05.2015, p. 217-225.

Research output: Contribution to journalReview article

Barletta, JF, Lat, I, Micek, ST, Cohen, H, Olsen, KM & Haas, CE 2015, 'Off-label use of gastrointestinal medications in the intensive care unit', Journal of Intensive Care Medicine, vol. 30, no. 4, pp. 217-225. https://doi.org/10.1177/0885066613516574
Barletta, Jeffrey F. ; Lat, Ishaq ; Micek, Scott T. ; Cohen, Henry ; Olsen, Keith M. ; Haas, Curtis E. / Off-label use of gastrointestinal medications in the intensive care unit. In: Journal of Intensive Care Medicine. 2015 ; Vol. 30, No. 4. pp. 217-225.
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abstract = "Purpose: Determine the level of evidence supporting off-label gastrointestinal (GI) medication use and identify the medication class and indication whereby off-label use was most common. Materials and Methods: This prospective, multicentered observational study evaluated all medication orders written in 37 intensive care units (ICUs) in the United States, over a 24-hour period. All medications classified as ''GI'' according to a national reference were identified. The class and indication whereby offlabel use was most prominent were determined and the level of evidence was described. Results: There were 774 orders from 363 patients and 63{\%} (489 of 774) were considered off-label. Proton pump inhibitors (PPIs) accounted for most of the off-label usage (55{\%} [271 of 489]), followed by laxatives (16{\%} [77 of 489]) and histamine-2-receptor antagonists (H2RAs; 15{\%} [71 of 489]). When prescribed, 99{\%} (271 of 274) of PPIs, 99{\%} (71 of 72) of H2RAs, and 79{\%} (30 of 38) of promotility agents were off-label. Stress ulcer prophylaxis (100{\%} [309 of 309]), GI bleeding (100{\%} [18 of 18]), and gastric motility (88{\%} [30 of 34]) were the most common off-label indications. The most common strength of recommendation and level of evidence for off-label use was indeterminate (58{\%} [282 of 489]) and none (57{\%} [280 of 489]), respectively. Conclusion: The PPIs are the most widely used off-label medications in the ICU. Stress ulcer prophylaxis is the most common indication. The level of evidence supporting off-label GI medication use is poor.",
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AB - Purpose: Determine the level of evidence supporting off-label gastrointestinal (GI) medication use and identify the medication class and indication whereby off-label use was most common. Materials and Methods: This prospective, multicentered observational study evaluated all medication orders written in 37 intensive care units (ICUs) in the United States, over a 24-hour period. All medications classified as ''GI'' according to a national reference were identified. The class and indication whereby offlabel use was most prominent were determined and the level of evidence was described. Results: There were 774 orders from 363 patients and 63% (489 of 774) were considered off-label. Proton pump inhibitors (PPIs) accounted for most of the off-label usage (55% [271 of 489]), followed by laxatives (16% [77 of 489]) and histamine-2-receptor antagonists (H2RAs; 15% [71 of 489]). When prescribed, 99% (271 of 274) of PPIs, 99% (71 of 72) of H2RAs, and 79% (30 of 38) of promotility agents were off-label. Stress ulcer prophylaxis (100% [309 of 309]), GI bleeding (100% [18 of 18]), and gastric motility (88% [30 of 34]) were the most common off-label indications. The most common strength of recommendation and level of evidence for off-label use was indeterminate (58% [282 of 489]) and none (57% [280 of 489]), respectively. Conclusion: The PPIs are the most widely used off-label medications in the ICU. Stress ulcer prophylaxis is the most common indication. The level of evidence supporting off-label GI medication use is poor.

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