Assessment of Knowledge and Attitude of Community Pharmacists towards of Label Medications in Khartoum State: A Descriptive Cross Sectional Study

Background: Healthcare providers, including pharmacists who prescribe medications, have a professional obligation to select treatments that are in the best interests of their patients. Consequently, the concept of off-label drug use, where drugs are used outside their approved indications, dosages, routes, or patient groups, often appears in medical literature, continuing education, and online resources. This term can be contentious, linked to both significant benefits and risks for patients. This study aimed to assess community pharmacists' knowledge and attitudes towards off-label medications. Methods: A descriptive cross-sectional study was conducted using a self-administered, 24-item questionnaire distributed to 330 randomly selected community pharmacies in Khartoum State from December 2020 to February 2021. Results: A 100% response rate was achieved. Most respondents were female (63.3%), aged 25-29 years (59.5%), and had 1-6 years of experience (36.6%). Over 75.1% were familiar with the concept of off-label prescribing, primarily through practical experience rather than formal education. Reasons mentioned for off-label prescriptions included indications (76.5%). More than half (62%) believed that prescribing off-label drugs is illegal, and only 16% felt they had adequate knowledge about off-label drug use. Despite concerns about safety (51%) and efficacy (54.7%), the majority of pharmacists relied on the British National Formulary (50%) or national guidelines (18.1%) rather than local formularies or package inserts for information. While 59.5% agreed they had a responsibility to inform prescribers about off-label use, 51.5% felt similarly towards informing patients. Regarding specific medications, 88% of respondents considered the use of metformin for obesity to be off-label, compared to 26.9% for pregabalin for neuropathic pain, and 66.7% and 31.3% for prazosin and clomiphene, respectively. Conclusion: Community pharmacists in Khartoum State appear to have limited awareness and concerns about the issues surrounding off-label prescribing. Most acquired relevant knowledge through work experience rather than formal training.