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Background Over 600 000 Australians currently live with severe physical and intellectual disabilities. Approximately two-thirds of these people are younger than 65 years of age. Home medication reviews are provided for residents of high-level care facilities of the South Australian Department of Disability and Social Inclusion ( DSCI). Aim To describe findings of a detailed analysis of medication use among a convenience sample of institution-dwelling adults with profound intellectual and physical disabilities. Methods Data were collected from a convenience sample of medication reviews conducted over a 12-month period. Descriptive and cross-tabular analysis of medication usage characteristics recorded in medication review reports were analysed with a focus on usage of antipsychotic, antidepressant and mood-stabilising agents. Dosage analysis was based on the Defined Daily Dose ( DDD). A specific focus addressed usage for non-approved purposes not within parameters of the Pharmaceutical Benefits Scheme. Results Initial analysis addressed medication use for 57 clients (mean age 52.96 years). The mean number of medications used was 10.3 (standard deviation 3.31) per client. Antipsychotics were prescribed for 20 clients (35.01%), antidepressants for 21 clients (36.84%) and anticonvulsants for 29 clients (50.88%). Usage for non-approved indications was observed in 41/57 cases. Off-label prescribing was most common with antipsychotics ( n = 16) and anticonvulsant drugs ( n = 14). Usage at doses greater than the DDD was observed in 28 cases, most commonly with antipsychotics. Conclusion This research is thought to be the first detailed analysis of medication use for people with profound disabilities in the Australian context. Data will be used to further explore aspects of treatments provided for these extensively medicated people, and to design strategies to minimise iatrogenic harm. [ABSTRACT FROM AUTHOR]