Deprescribing is a systematic process of reducing or stopping medications. This approach aims to improve a person’s overall health and quality of life by minimizing potential harm from drugs that are no longer beneficial or are causing adverse effects. It involves evaluating an individual’s medication regimen, considering their current health status, care goals, and the balance of risks versus benefits for each drug. The objective is to reduce medication burden while maintaining or enhancing well-being.
Reasons for Reducing Medications
Polypharmacy, often defined as regularly taking five or more medications, is a common issue deprescribing addresses, particularly in older adults and those with multiple health conditions. This can lead to various problems, including an increased risk of adverse drug reactions (ADRs), where medications cause unintended and harmful effects. For instance, certain drugs can cause dizziness, confusion, or falls, especially in older individuals.
Drug-drug interactions are another concern, occurring when medications negatively affect each other’s actions, potentially leading to reduced effectiveness or increased toxicity. A medication might also become less effective over time, or the condition it was prescribed for may have resolved, rendering the drug unnecessary. Unnecessary medication use can negatively impact a person’s daily function, affecting their energy levels, cognitive abilities, and overall independence. The financial burden of multiple prescriptions can also be substantial, leading to reduced adherence due to cost.
When Medication Reduction is Considered
Deprescribing is considered for older adults due to age-related changes in how their bodies process medications and their increased likelihood of having multiple chronic conditions. Individuals experiencing side effects from their medications, such as fatigue, confusion, or gastrointestinal issues, are also candidates for medication review. When a medical condition has resolved or a drug no longer has a clear ongoing purpose, its continuation should be re-evaluated.
Common classes of medications often targeted for deprescribing include:
Benzodiazepines, used for anxiety and sleep, which can cause sedation and increase fall risk.
Proton pump inhibitors (PPIs), used for acid reflux, especially with long-term use.
Certain diabetes medications, particularly in patients with a limited life expectancy, to reduce the risk of hypoglycemia.
Anticholinergic drugs, which can affect the brain and other organs, due to their potential for adverse effects like cognitive impairment and dry mouth.
How Medication Reduction is Managed
The process of deprescribing is a collaborative effort involving the patient, their doctor, and often a pharmacist. It begins with a comprehensive review of all medications the patient is taking, including prescription drugs, over-the-counter products, supplements, and herbal remedies. This review helps identify medications that might be unnecessary, ineffective, or potentially harmful given the patient’s current health status and goals.
Once potential targets for reduction are identified, shared decision-making becomes central. The healthcare team discusses the benefits and risks of continuing versus stopping each medication, incorporating the patient’s values, preferences, and priorities. A personalized plan is then created, often involving a gradual reduction or tapering of the medication dose rather than abrupt cessation, to minimize withdrawal symptoms and allow the body to adjust. Monitoring is conducted to assess the effectiveness of changes and to detect any adverse effects or withdrawal symptoms.
Understanding Patient Concerns
Patients often have concerns about deprescribing, including fears that their underlying condition might worsen without the medication. They might also worry about experiencing withdrawal symptoms, which can occur when certain medications are stopped or reduced too quickly. Some patients may also feel a loss of control over their health management or worry about the effort involved in adjusting to a new medication regimen.
Healthcare providers address these concerns through careful planning and open communication. They explain the rationale behind deprescribing, emphasizing that the goal is to improve health outcomes and quality of life, not to abandon necessary treatment. Gradual tapering schedules are implemented to minimize withdrawal effects, and patients are closely monitored for any changes in their condition or new symptoms. This approach reassures patients and empowers them to participate actively in decisions about their medication management.