Please note: You can also download a copy of this information leaflet at the bottom of this page or view our full list of information leaflets.

In the field of Palliative Care (symptom control) and Paediatrics (children), it is common practice to prescribe medicines that are used beyond the confines of their licence. This leaflet explains what this means and how it may affect you.

What is meant by a licence?

Medicines prescribed by your doctor or bought over the counter are licensed for use by the Medicines and Healthcare Products Regulatory Authority (MHRA).

When a manufacturer of drugs markets a new medicine, they must obtain a licence from the Medicines and Healthcare Products Regulatory Authority (MHRA). The licence states the conditions for which the medicine may be used, the doses, and the age range of the patients it may be given to.

Manufacturers have to include a Patient Information Leaflet, which contains all the conditions on the licence.

What is meant by the use of a medicine outside the licence?

After a medicine has been in use for some time, it often becomes clear that it is effective in conditions, doses or by administration routes that are not specified on the licence. This commonly occurs for medicines used to treat pain, cancer and children. There is no legal requirement for manufacturers to extend the licence. For most of them, this procedure is too costly to pursue and the drug has already been well researched in other settings.

Can doctors prescribe medicines outside their licence?

Yes, and this is common place in palliative medicine where medicines are used to control symptoms such as pain, and where prescribing for children is concerned.

However, doctors employed or contracted by St Barnabas or Chestnut Tree House Hospices only do this when there is good experience or research to support such use, and when there is no suitable alternative licensed medicine. The doctors will carefully consider what medicines might best suit your needs.

How will you know your medicines have been prescribed out their licence?

You can tell if a medicine has been used outside the product licence, if the Patient Information Leaflet supplied by the manufacturer does not contain information on your condition.

Many medicines prescribed by doctors at St Barnabas and Chestnut Tree House Hospices are outside their licence but used within widely accepted limitations of evidence, research and common practice in the specialities of Palliative Medicine and Paediatrics. The prescribing doctor may not inform you specifically of this.

Whether within license or not, the doctor should give you a clear explanation of the medications prescribed and discuss with you the expected benefits and possible side effects.

Seeking consent for the use of a medicine outside its licence

The doctors will seek your consent for the use of a medicine outside its licence only if it is not commonly accepted practice within the speciality to use the medicine in question. We would only consider prescribing such medication after reviewing the research, consulting with other specialists, and if there is no suitable alternative available. This situation rarely arises.

Do you have any questions?

If you have concerns about any of the information contained in this leaflet or about your medicines, please do not hesitate to talk to a doctor or nurse who will be pleased to help.