It is defined as the process of withdrawal of an inappropriate medication, supervised by a healthcare professional, with the goal of managing polypharmacy and improving outcomes.
It concerns the overuse of medications, or use of certain ones for too long—in general, polypharmacy.
Polypharmacy and potentially inappropriate medications have been associated with many negative health outcomes, including reduced quality of life, adverse drug reactions, addiction, falls, nonadherence, hospitalizations, and mortality.
Other benefits of deprescribing may include reduced cost and perhaps improved patient adherence.
How to do it? Following a stepped process.
- The medication history.
- The patient's adherence to the medications
- The risks and benefits depending on individual patient factors.
- The goals of care of those medications and their continuation.
- The drug-related factors: polypharmacy, pill burden, medication regimen, drug/drug interactions, the use of specific high-risk drugs.
- The patient factors: life expectancy, cognitive and functional factors, impairment the medications are causing, multiple prescribers.
- Which medications are most important to the patient.
- Which are potentially inappropriate medications.
- Which medications do not have specific indication
- Which medications has questionable efficacy or alters the risk in combination with other medications.
- What to start with first.
- The appropriate time
- The tapering or withdrawal process
- The control of the benefits and the harms of medication withdrawal.
Web resources with useful guidelines.
Risk: making medicines safer for all of us.
See reference for more information.
Adapted from Medscape News & Perspective. Targeting unnecessary meds: A guide to deprescribing. Internet. Available at https://www.medscape.com/viewarticle/880516?src=wnl_edit_tpal&uac=6705FY#vp_1 . Accessed on April 29, 2018. To view the entire article and all other content on the Medscape News and Perspective site, a free, one-time registration is required.