Abstract: OBJECTIVE To retrospectively analyze the off-label drug use in neurology outpatient department of The First Affiliated Hospital of Zhengzhou University, so as to provide reference for classification management of off-label drug use, promote rational drug use in clinic, and ensure the safety of drug use. METHODS Prescriptions of neurology outpatient department during June—September 2020 were randomly selected. According to latest drug instructions, off-label drug use of these prescriptions was analyzed, including the category of off-label drug use and incidence of off-label drug use with different category of drugs. According to foreign instructions, international/domestic guidelines, expert consensus and other evidence-based support usage, the level of evidence for off-label drug use was analyzed. Meanwhile, univariate analysis was used to explore risk factors for off-label drug use. RESULTS A total of 1 663 outpatient neurology prescriptions with 3 240 medication orders were extracted, including 190 kinds of drugs. There were 307 prescriptions(18.46%), 334 medication orders(10.31%) and 30 kinds of drugs(15.79%) for off-label use, respectively. The main types of off-label drug use were off-label indication and off-label drug frequency medication. There were 293(87.72%) medical orders supported by evidence in 334 off-label drug orders. Univariate analysis showed that off-label drug use in neurology department was related to drug type. CONCLUSION Off-label drug use is common in the outpatient department of neurology, and most has certain evidence support and inevitability, the supervision of off-label drug use should be strengthened according to the evidence levels to ensure rational clinical drug use.