# Beyond the label: ethical and clinical implications of off-label drug use in pediatric emergency care

**Authors:** Marco Colombo, Anna Plebani, Massimo Agosti

PMC · DOI: 10.1186/s13052-025-02176-4 · Italian Journal of Pediatrics · 2025-12-13

## TL;DR

This paper discusses the ethical and clinical issues of using unapproved drugs in pediatric emergency care and suggests ways to improve safety and guidelines.

## Contribution

The paper introduces a case study and proposes strategies to address ethical and regulatory challenges in off-label drug use for children.

## Key findings

- Off-label drug use is common in pediatric emergency care due to limited clinical data.
- The practice raises ethical and legal concerns despite being potentially lifesaving.
- Improved informed consent and evidence-based guidelines are needed for safer off-label use.

## Abstract

Off-label prescribing, the use of medications outside of approved indications, is a common practice in pediatric emergency medicine. This practice is driven by factors such as limited pediatric-specific clinical trial data, regulatory hurdles, and the urgent need to treat critically ill children. While off-label prescribing can be lifesaving, it raises significant ethical and legal concerns. This article explores the prevalence, challenges, and potential consequences of off-label drug use in pediatric emergency departments. A case study illustrates the complexities of off-label prescribing in a real-world clinical scenario. The discussion highlights the importance of balancing clinical needs with regulatory requirements and ethical considerations. Future research should focus on optimizing informed consent procedures, enhancing postmarketing surveillance, and developing evidence-based guidelines to ensure the safe and effective use of off-label medications in pediatric emergency care.

## Full-text entities

- **Diseases:** critically ill (MESH:D016638)

## Full text

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## References

7 references — full list in the complete paper: https://tomesphere.com/paper/PMC12817774/full.md

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Source: https://tomesphere.com/paper/PMC12817774