Even after so many years of clinical practice, we have to sometimes look up some basic information about medications that we don’t use on a daily basis.
For example, I sometimes look up the following on this website (simpleandpractical.com):
1. What dosage strengths does a medication come in? I recently had to look this up for chlordiazepoxide, a medication I prescribe only occasionally.
2. The FDA-recommended maximum dose for a medication. If we use more than the FDA-recommended dose, we should document that we discussed this with the patient. Also, we should write the reason why we are using a higher dose than the recommended one.
3. Whether my intended use of the medication is off-label. Again, several forensic psychiatrists and malpractice lawyers have recommended to me that we should always tell the patient that the use of medication is off-label.
Please don’t roll your eyes! 🙂
Whether you like it or not, whenever something goes wrong, it looks bad in a lawsuit that the clinician is either disregarding what the FDA says or did not get consent from the patient to do something that the manufacturer and the FDA do not recommend. For off-label use (olu), even just writing in the note something like “Olu d/w pt” is helpful.
Did you know that it is very easy to find this information on this website? Just type in simpleandpractical.com/xxx where xxx represents the name of the medication. Use the generic, not the brand name. For example, simpleandpractical.com/paliperidone or simpleandpractical.com/zaleplon, and so on.
Please do let me know what you think in the box at the bottom of this page under “Leave a Reply”.
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These are good ideas. I think it is also good risk management to include the indication whether off or on label on the Rx itself. I tend to handle informed consent whether on or off label in same way with treatment goals, target sx, and major risks, adverse effects either way, plus that it is off label when that is the case documented in the medical record. So dosing modafinil for fatigue in an MS patient, I will state on Rx “for MS related fatigue” and then document that I have provided pt a copy of the the MS society guideline for management of fatigue which specifically discusses modafinil and other medication with some evidence base for this off label indication. If prescribing very high doses, I do the same with justification for high dose i.e., if on hepatic enzyme inducer like carbamazepine, put that right on the Rx, or if patient has a BMI of 40+ for a medication where dosing is related to body mass, I include the BMI on the Rx, e.g., for methylphenidate which is typically dosed at 0.5 to 1 mg/Kg/24 hours, this does seem to help with approval for 40 mg of methylphenidate TID in a patient at 180 Kg body mass.
Thanks, Dr. Straus, for these great suggestions!