Off-label prescription of benzodiazepines: a retrospective cohort study of prescribing prevalence in primary care.

Off-label prescription of benzodiazepines: a retrospective cohort study of prescribing prevalence in primary care. | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 17 February 2025 V1 Latest version Share on Off-label prescription of benzodiazepines: a retrospective cohort study of prescribing prevalence in primary care. Authors : Kevin Trimm 0009-0002-1939-4217 [email protected] , Maria-Teresa Moraga , Bärbel Knäuper , Elham Rahme 0000-0002-4168-4993 , Emily Mcdonald , and Robyn Tamblyn Authors Info & Affiliations https://doi.org/10.22541/au.173982075.53144180/v1 Published Clinical Drug Investigation Version of record Peer review timeline 351 views 223 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background Benzodiazepines are commonly prescribed medications approved for and used in the treatment of anxiolytic and sleep disorders, as well as for seizures, and alcohol withdrawal. However, benzodiazepines are also controlled substances (schedule IV in Canada) because of their potential for abuse and personal harms, which are especially prevalent among older people. It is therefore important to understand how benzodiazepines are being prescribed, and the prevalence of off-label benzodiazepine prescribing, of which very little is known due to challenges in documenting treatment indication. Methods Data from the MOXXI (Medical Office of the XXIst century) electronic health record system in Quebec Canada was used, where specifying the treatment indication for each prescription is required, to estimate the prevalence of off-label prescribing and indications for off-label use of benzodiazepines. Each drug indication was retrospectively classified as either on-label or off-label according to the Health Canada drug database. Off-label prescriptions were further classified as having class evidence supporting their prescription if another benzodiazepine had been approved for the indication by Health Canada. Results There were 20,125 (17.0%) adult patients prescribed benzodiazepines out of the 118,227 patients enrolled in the MOXXI system. The patients were predominantly female (65.6%), and tended to be older with an average age of 60.14 years (standard deviation = 15.68) at the time of the first benzodiazepine prescription. A total of 101,583 unique prescriptions were written for 14 different benzodiazepines to these patients. An approximately equal number of benzodiazepines were prescribed on and off-label (49.3% on-label, 49.2% off-label), with clonazepam having the highest prevalence of off-label prescription (99.5%). Most off-label prescription indications were classified as having class evidence (95.2%). The most common off-label indication was insomnia; 31.6% of all off-label benzodiazepine prescriptions were for insomnia. Conclusions We found that benzodiazepines were frequently prescribed in the province of Quebec and were prescribed off-label approximately half of the time. When prescribed off-label we found that the majority of these prescriptions were for indications that were approved for at least one benzodiazepine. These findings indicate the importance of reminding physicians on the important differences between benzodiazepines that can substantially impact patient outcomes, particularly in older people. Supplementary Material File (pds-25-0118-file001.docx) Download 73.47 KB Information & Authors Information Version history V1 Version 1 17 February 2025 Peer review timeline Published Clinical Drug Investigation Version of Record 5 Sep 2025 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords benzodiazepines off-label primary care Authors Affiliations Kevin Trimm 0009-0002-1939-4217 [email protected] McGill University View all articles by this author Maria-Teresa Moraga McGill University View all articles by this author Bärbel Knäuper McGill University View all articles by this author Elham Rahme 0000-0002-4168-4993 McGill University View all articles by this author Emily Mcdonald McGill University View all articles by this author Robyn Tamblyn McGill University View all articles by this author Metrics & Citations Metrics Article Usage 351 views 223 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Kevin Trimm, Maria-Teresa Moraga, Bärbel Knäuper, et al. Off-label prescription of benzodiazepines: a retrospective cohort study of prescribing prevalence in primary care.. Authorea . 17 February 2025. DOI: https://doi.org/10.22541/au.173982075.53144180/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. 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