Can I prescribe unlicensed/off-label medicines in palliative care?

The GMC's existing prescribing guidance is clear that you may prescribe unlicensed medicines where this is necessary to meet the specific needs of the patient and there is sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy.

NICE guidance on managing coronavirus symptoms refers to the use of opioids and benzodiazepines for management of patients at end of life.

It guides doctors to, "Consider an opioid and benzodiazepine combination for patients with COVID-19 who:

  • are at the end of life and
  • have moderate to severe breathlessness and
  • are distressed."

The guidance acknowledges that these are indications for which the drugs do not have a UK marketing authorisation.

In a joint statement on community based prescribing for COVID-19 patients, the GMC states, "it is entirely appropriate to follow these guidelines and that we would not have concerns about prescribing decisions based upon them."

Doctors should use their clinical judgement including the use of appropriate alternatives when certain drugs are not available.

This page was correct at publication on 22/04/2020. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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