What is deprescribing and why you should want it?!

What is deprescribing and why you should want it?!  Deprescribing is the act of removing medications that are no longer needed or beneficial.

Our health care system is geared toward starting medications and not stopping them.  Did you know that nearly half of older adults take five or more medications and studies have shown that as many as 20% of the prescriptions are potentially inappropriate?

Polypharmacy is the concurrent use of multiple medications by a patient.  When medications are combined in the body, there is a potential for harm as medications may interact with each other or conditions or cumulative harms can outweigh the medication’s benefits.

What should be done?  This is a prime opportunity for shared decision making between the physician and patient AND to focus on the patient and their wishes.

Your physician should prioritize ongoing treatments.  Which medications should continue?

Assess your body’s ability to break down the medication.  As we age our ability to metabolize the medication through our liver or kidneys may decrease.  This may mean that a medication dosage should be decreased or stopped to avoid adverse effects.  This lower dosage may still achieve the same benefit.

As we age our goals of treatment evolve.  This conversation allows patients the choice regarding continuing or stopping medications.  For instance, when you are 90 years old do you want to take a cholesterol-lowering medication?

How should your physician go about this deprescribing pathway?

  1. Identify potentially inappropriate medications (Is it causing drowsiness which may lead to a fall?)
  2. Can the dose be reduced?  or the medication discontinued? (Was the medication started for a condition like reflux which is now controlled?)
  3. make a plan to taper medication dosage (Should a drug holiday be used to see if symptoms recur?  or just taper and then discontinue?)
  4. monitor the patient for symptoms requiring restarting or increasing dosage of medication
  5. document outcomes in the chart (like how is the blood pressure now that the medication has been changed)
elderly people walking

flickr.com/ photos/ tokaris/ 207335658

Want more information?

http://medstopper.com/  is a deprescribing tool for both patients and physicians.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339726/

I hope this helps.

Advertisements

About drlesliegreenberg

I have been practicing as a family physician for over 20 years--as both an educator of physicians and clinician. From infancy to the elderly, I perform obstetrics and general medicine. I love my career and am passionate about my field of knowledge and my patients. Follow me on Facebook at Leslie Md Greenberg Medical Disclaimer The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.
This entry was posted in end-of-life issues, General Medicine- Adults, medication issues, Uncategorized and tagged , , , , , , , , , , , , , , . Bookmark the permalink.