Deprescribing

Question 1

Deprescribing definition

Answer 1

The systematic process of identifying and discontinuing drugs in instances in which existing potential harms outweigh existing or potential benefits within the context of an individual patient’s care goals, current level of function, life expectancy, values, and preferences.

Question 2

How to deprescribe medications

Answer 2

Ascertain all drugs the patient is currently taking and the reasons for each one

Consider overall risk of drug-induced harm in individual patients to determine the required intensity of deprescribing intervention

Assess each drug for its eligibility to be discontinued

Prioritize drugs for discontinuation

Implement and monitor drug discontinuation regimens

Question 3

Deprescribing BZDs

Answer 3

Taper the dose by 25% every week until 50% of the dose is reached, then decrease dose 1/8 every 4-7 days. Monitor for side effects and adjust the taper regimen accordingly

(From PHM 701)

Question 4

Patient factors for deprescribing drugs

Answer 4

age >80, cognitive impairment, multiple comorbidities, substance abuse, multiple prescribers

Question 5

Good candidates for deprescribing

Answer 5

no valid indication, part of a prescribing cascade, harm outweighs the potential benefit, TTB vs TTH, drugs imposing unacceptable treatment burden

Question 6

How to get patients on board with getting meds deprescribed

Answer 6

D/C the easiest meds first (ones that the patient are most willing to D/C) to gain a buy-in, then D/C one agent at a time and move on to other meds