Off-Label Usage of Medications

The United States Food & Drug Administration (FDA) is responsible for regulating both prescription and non-prescription medications. One of their roles in regulation is to ensure that medications are safe and effective. This is done through the FDA approval process.

What are off-label medications?

This means it is used in a way that is not stated in the FDA labeling. Medications may be used off-label for several reasons such as:

  • For a disease or condition that it is not approved to treat. For example, using an antidepressant medication to treat nerve pain.
  • At a different dose than approved. For example, a lower or higher dose of the medication may be used for some patients.
  • In different dosage form than approved. For example, a medication that is approved for use with an oral tablet but prescribed with an oral solution.

Why are medications used off-label?

Off-label use of medications is common. Although common, many patients may not know that a medication is prescribed off-label. So why are medications used off-label?

One reason may be that the FDA approval process is expensive and time-consuming. If the company would like to add an indication to a medication an additional application is required. For this reason, a medication may still be helpful for off-label use even if it is not approved by the FDA. Off-label use of medications can be particularly useful for patients who have tried all other medications for a disease. Another reason a medication may be prescribed off-label is because there might not be an approved drug to treat a disease. One example is cancer medication. Often a cancer medication may be approved to treat one type of cancer, but is used off-label to treat other types of cancers. Although a medication is not approved for a condition, it may have been studied for its benefits in that condition.

How does a doctor decide to use a medication off-label?

Once a medicine is approved for one use, doctors can decide whether it is right for other uses. Several factors are considered when a physician decides to prescribe a medication. This includes deciding whether the medication is safe and effective for a specific patient.

Is it safe to use a medication off-label?

In most cases, taking a medication for off-label use is safe. Drug companies are required to prove that a medication is safe for people to use. They just don’t need to prove the drug works for treating an off-label condition. And sometimes a medication could help with symptoms of conditions that it was not approved for. There are many off-label uses that most doctors agree are safe and effective.

Examples of off-label medication use for mental health conditions

  • Amitriptyline: insomnia, posttraumatic stress disorder (PTSD)
  • Clonidine: smoking cessation, excessive saliva caused by clozapine
  • Gabapentin: alcohol dependence, social anxiety 
  • Prazosin: posttraumatic stress disorder (PTSD) nightmares
  • Topiramate: alcohol dependence, weight gain caused by antipsychotic medication, binge eating disorder, bulimia
  • Trazodone: insomnia


Provided by

©2019 The College of Psychiatric and Neurologic Pharmacists (CPNP). Aimee Patterson, PharmD, March 2019

This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the topic. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein. CPNP makes this document available under the Creative Commons Attribution-No Derivatives 4.0 International License. Last Updated: January 2016.​

To view the references for this resource, please visit