Background and importance It is very important to analyse the dispensing conditions of all drugs outside the hospital guide in order to update the pharmacotherapeutic guide when appropriate, and thus minimise out-of-guide prescriptions when there is insufficient evidence.

Aim and objectives To evaluate prescriptions for drugs not included in the pharmacotherapeutic guide to advise the medical director on their approval.

Material and methods Data were collected for all medications not included in the pharmacotherapeutic guide requested from the hospital pharmacy service throughout the year. Analysis of the data was carried out, differentiating two types of situations: (a) medications not susceptible to therapeutic exchange; and (b) medications of low therapeutic usefulness (LTU) according to the pharmacotherapeutic guide of the Murcian Health Service.

The characteristics of LTU drugs were: (a) their therapeutic usefulness had not been proven in clinical studies carried out under adequate conditions; (b) insufficient benefit–risk ratio; (c) associations not recommended, such as those in which the combination of two or more drugs does not provide any advantage over the administration of the drugs separately or those that include a drug of low therapeutic utility.

Results 66 treatments with medications not included in the guide were collected, corresponding to 40 different patients, for a total of 190 dispensations. 52 (79%) were not interchangeable and 14 (21%) were LTU drugs. Three pharmacological groups accounted for 33.3% of all treatments: urinary antispasmodics, antidepressants (both 12.1%) and antiasthmatics (9.1%).

Conclusion and relevance Most of the expenditure on drugs not included in the hospital guide was from the acquisition of drugs for which it was assumed that there was no other interchangeable option in the pharmacotherapeutic guide. Three pharmacological groups accounted for a third of the total cost of these drugs. For this reason, the actions in these groups should be prioritised, proposing their replacement, whenever possible, and evaluating the possibility of including them in the hospital guide, thereby reducing the cost of acquisition.

In view of the results, the pharmacy and therapeutics commission decided to include one of the antidepressants in the hospital guideline due to its cost–benefit. It might be advisable to reinforce the pharmacist’s interventions in this regard to instil in prescribers the importance of adjusting the treatment to the hospital guidelines.

Conflict of interest No conflict of interest