Off-label prescriptions of drugs or devices have been described as an integral part of medical practice. This involves prescriptions for indications or patient populations that are not indicated in the drug or device’s registration and extends to dosages or methods of administration beyond label specifications. The Singapore courts have recently disciplined medical practitioners for professional misconduct involving various forms of off-label prescriptions. In doing so, they have articulated clearer standards expected of doctors in Singapore in relation to this clinical phenomenon. The presentation will examine the legal principles, ethics and implications of the decisions and situate the issues within the larger regulatory framework in relation to the use of drugs and devices. It will consider if further reforms are needed to bolster the protection of patients while encouraging off-label prescriptions that further the best interests of patients and the public health interest.