Good practice in proposing, prescribing, providing and managing medicines and devices

Prescribing unlicensed medicines

102

In this guidance, the term ‘unlicensed medicine’ is used to describe medicines, which are used outside the terms of their UK licence or that have no licence for use in the UK.34 Unlicensed medicines are commonly used in some areas of medicine, such as in paediatrics, psychiatry and palliative care. They are also used, albeit less frequently, in other areas of medicine.

103

You should usually propose, prescribe or provide licensed medicines in accordance with the terms of their licence. However, Unlicensed medicines may be appropriate where, on the basis of an assessment of the individual patient, you conclude, for medical reasons, that it is necessary to do so to meet the specific needs of the patient.

104

You should usually prescribe licensed medicines in accordance with the terms of their licence. However, you may prescribe unlicensed medicines where, on the basis of an assessment of the individual patient, you conclude, for medical reasons, that it is necessary to do so to meet the specific needs of the patient.

105

If proposing, prescribing or providing an unlicensed medicine, you must:

  1. be satisfied that there is sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy
  2. take responsibility for prescribing the medicine (or ensuring that the person you are proposing the prescription to is aware that the medicine is unlicensed, and the reasons why) and for overseeing the patient’s care, monitoring and any follow up treatment (or make sure that arrangements are in place for another suitable medical professional to do so)
  3. make a clear, accurate and legible record of all medicines prescribed and, where you are not following common practice, your reasons for prescribing an unlicensed medicine.

Information for patients about the licence for their medicines

106

You must give patients, or their parents or carers, sufficient information about the medicines you propose to prescribe, to allow them to make an informed decision.

107

Some medicines are routinely used outside the terms of their licence, for example in treating children. In emergencies or where there is no realistic alternative treatment and such information is likely to cause distress, it may not be practical or necessary to draw attention to the licence. In other cases, where prescribing unlicensed medicines is supported by authoritative clinical guidance, it may be sufficient to describe in general terms why the medicine is not licensed for the proposed use or patient population.38 You must always answer questions from patients, or their parents or carers, about medicines fully and honestly.

108

If you intend to propose, prescribe or provide unlicensed medicines where it’s not routine or if there are suitably licensed alternatives available, you should explain this to the patient, and give your reasons for doing so.