Fda Drug Prescribing Warnings: Is the Balck Box Half Empty or Half Full?

Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
Pharmacoepidemiology and Drug Safety (Impact Factor: 2.94). 06/2006; 15(6):369-86. DOI: 10.1002/pds.1193
Source: PubMed


Black box warnings (BBWs) are the Food and Drug Administration's (FDA) strongest labeling requirements for high-risk medicines. It is unknown how frequently physicians prescribe BBW drugs and whether they do so in compliance with the warnings. The purpose of the present study was to assess the frequency of use of BBW medications in ambulatory care and prescribing compliance with BBW recommendations.
This retrospective study used automated claims data of 929 958 enrollees in 10 geographically diverse health plans in the United States to estimate frequency of use in ambulatory care of 216 BBW drugs/drug groups between 1/1/99 and 31/6/01. We assessed dispensing compliance with the BBW requirements for selected drugs.
During a 30-month period, more than 40% of enrollees received at least one medication that carried a BBW that could potentially apply to them. We found few instances of prescribing during pregnancy of BBW drugs absolutely contra-indicated in pregnancy. There was almost no co-prescribing of contra-indicated drugs with the two QT-interval-prolonging BBW drugs evaluated. Most non-compliance occurred with recommendations for baseline laboratory monitoring (49.6% of all therapy initiations that should have been accompanied by baseline laboratory monitoring were not).
Many individuals receive drugs considered to carry the potential for serious risk. For some of these drugs, use is largely consistent with their BBW, while for others it is not. Since it will not be possible to avoid certain drug- associated risks, it will be important to develop effective methods to use BBWs and other methods to minimize risks.

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    • "These studies find significant (although generally modest) declines in prescribing in response to FDA information. However, one study found that 40 percent of patients received at least one medication with a black-box warning that could have applied to them, suggesting that FDA warnings may not result in targeted reductions in use of labeled drugs (Wagner et al. 2006). Past studies have also examined consumption responses to various forms of medical information, such as drug withdrawals, medical report cards, and academic studies. "
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