Quote from bobbyzr7
Hi, I read my state's practice act, but can't tell if prescribing meds for off label use is permitted by NPs. Do any of you do it? This question has been bugging me for a while, so I'd like to hear from practicing NPs about this . I am in a FNP program, and graduate in December 2012. Thanks!
I'll come in with a different perspective. Off label use is any use where the indication, dosage, age group or form of administration was not approved.
On a routine basis we use drugs in ways that are not approved. The reason is that either for financial reasons or because of bureaucratic delays drugs may never get the specific indication for the use.
For example in the ICU we use Seroquel for delirium. The indications are Bipolar disorder, Schizophrenia and Acute depression. Given that it will shortly become generic its unlikely that there will ever be a delirium indication. However, there are multiple studies and and guidelines that recommend its use. The key is knowing what the background for the drug is and what the current practice patterns and research are.
The more specialized you are the more likely you will find yourself using a drug off label. In Peds GI for example when I was practicing none of the PPIs were approved for use in children. However with a wealth of research we prescribed them for all ages and worked with compounding pharmacies get acceptable forms.
In answer to your particular question I am not aware of any State that requires NPs to prescribe only for on label indications. For medications most states follow the medical practice act and allows prescription of approved drugs regardless of the indication. There are some special restrictions around potential abortifactants but otherwise indication is not addressed.
The key is to follow the old maxim of don't be the first and don't be the last. Don't be too cutting edge (Propofol in the bedroom comes to mind) don't cling to the indication after the standard of practice has move on.