eng Oriental Scientific Publishing Company Biomedical and Pharmacology Journal 0974-6242 2025-12-30 18 4 2504 2514 10.13005/bpj/3273 69405 article Muhammad Irfan Siddique 1 Shakeel Ahmad 2 Abida khan 3 Department of Pharmaceutics, College of Pharmacy, Northern Border University, Rafha, Saudi Arabia. Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences: Center for Health Research, Northern Border University, Arar, Saudi Arabia. The use of antipsychotic drugs has expanded beyond their approved indications for schizophrenia and bipolar disorder to include conditions such as insomnia, anxiety, dementia-related behavioral disorders, and pediatric behavioral issues. This review examines prescribing trends, clinical motivations, and ethical concerns surrounding the use of antipsychotic medications across different populations. Second-generation agents—such as risperidone, quetiapine, olanzapine, and aripiprazole—are preferred for off-label use due to their favorable side-effect profiles and reduced risk of extrapyramidal symptoms. However, off-label prescriptions often lack robust supporting evidence, increasing the risk of metabolic syndrome, cardiovascular complications, cognitive decline, and higher mortality among vulnerable patients. Drivers of off-label use include limited approved options, physician practice patterns, and pharmaceutical promotion. Ethical prescribing requires evidence-based justification, informed consent, and vigilant monitoring. This review underscores the need for stricter regulatory guidelines, stronger evidence, and a patient-centered approach to safeguard responsible off-label use of antipsychotic medications. https://biomedpharmajournal.org/vol18no4/trends-in-the-use-of-antipsychotics-for-off-label-indications-clinical-and-ethical-considerations/ Antipsychotics Dementia Ethical considerations Metabolic side effects Off-label prescribing Pediatric psychiatry Second-generation antipsychotics