What is deprescribing?
- Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit.
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The steps in deprescribing
1. Review of all current medications.
The first step in deprescribing is medication reconciliation, often centered around a “brown bag” review. We instruct the patient to bring all of his or her medications (including prescription drugs, over-the-counter medications, and supplements such as vitamins and minerals) to a visit, and take a medication history.
2. Identify any inappropriate, unnecessary, or harmful medications
. Together with the patient, we review all medications listed in the updated medication list and consider which ones are offering benefit and which are causing harm. We Look for medications that are potentially inappropriate ( lack efficacy, lack an indication, don't provide additional benefit, or require a long duration for effect.
We also consider whether the patient would like to stop any medications because of negative side effects or whether any medications have complex dosing regimens that could be avoided
3. Plan deprescribing with the patient.
Many patients resist stopping medications, especially those they have been taking for a long time. They may be concerned about their conditions worsening or about contradicting the original prescriber.
At the Life Clinic, we discontinuing one medication at a time or taper medication dose down. necessary, and assure patients that we will monitor them for worsening conditions or withdrawal effects.
We also, discuss the potential or real adverse effects of their medications; the potential benefits of deprescribing, such as reduced risk of hospitalization, cognitive or functional gains, and improved quality of life; and the minimal (if any) impact deprescribing would have on their conditions.
3. Plan deprescribing with the patient.
4. Regularly rereview medications. Because deprescribing may require tapering of medications or may involve withdrawal symptoms, the process needs to be monitored closely. Additionally, on at least an annual basis (if not at every visit), we look closely at all medications again. Many patients see multiple providers and can quickly accumulate medications across conditions. As much as we are able, we actively engage our specialist colleagues in discussions of benefits and harms of new medications, as well as other options. One way to facilitate this is by using electronic or paper consultation reports that clearly list new or modified medications.
