Deprescribing medication

There are two relatively new  terms in medical jargon that are worth knowing:

  • Polypharmacy: Taking a large number of prescription medications.
  • Deprescribing: Systematically reducing or eliminating medications that have been prescribed for a patient.

Pharmaceutical companies obviously provide information about when a drug should be used and about side effects that might indicate that the drug should not be used.

What’s rare is information about when a drug ceases to be effective or of value to the patient. Thus as people age, they tend to add prescriptions, and continue them beyond the point of the drug having any real value to the patient.

Dr Farrell notes that at her hospital in Ottawa, it is not unusual to see a patient on 25-30 medications. “Frequently, a medication is started to see whether it will help with certain symptoms—almost like a diagnostic test—but then the medication is never stopped,” she explains. “Ten years go by, and the family doctor retires or dies, and the patient sees a new family doctor who doesn’t know why the drug was prescribed in the first place but is scared to stop it. I see patients in their 80s and 90s who have been on a medication for 30 years, and no one can remember why they are taking it.” (1)

The Canadians are ahead of the US in tackling this issue, even though drug costs are substantially lower in Canada than in the US.

Dr. Barbara Farrell is a clinical scientist at the Bruyère Research Institute and the C.T. Lamont Primary Health Care Research Centre, and assistant professor in the Department of Family Medicine, University of Ottawa, Canada. She is a cofounder of the Canadian Deprescribing Network and codeveloper of deprescribing.org, a website for the dissemination and exchange of information about deprescribing approaches and research. (1)

Her Canadian team is in the process of developing guidelines for reducing or eliminating the medications prescribed for a patient.

Why is this important?

  • Some drugs lose or even reverse their effects over time (e.g., the cancer drug, tamoxifen, which can be used for no more than five years)
  • A drug to fight one illness may aggravate another condition the patient develops
  • There may be long term interactions or complex interactions from combinations of four or more medicines
  • A drug may simply cease to be of value to a patient. If a patient is confined to bed with dementia, does the cholesterol level really matter?
  • Costs

What you should consider:

  • Do you know what the medications you are taking do?
  • Have you talked with your doctor about whether you could reduce dosages?
  • Have you talked with your pharmacist recently about drug interactions and whether there are any long term risks to using a drug?

Ultimately, you’re the custodian of your body. Like a house or a car, your body needs maintenance and you need to be in control.


Sources:

  1. Lisa Brooks, “Easy to Start, Hard to Stop: Polypharmacy and Deprescribing,” Medscape, 1 June 2017. http://www.medscape.com/viewarticle/880716?nlid=115489_1521&src=WNL_mdplsfeat_170606_mscpedit_wir&uac=153634BV&spon=17&impID=1362583&faf=1
  2. Deprescribing.org/
  3. I A Scott et. al., “Reducing inappropriate polypharmacy: the process of deprescribing,” JAMA Intern Med. 2015 May;175(5):827-34. doi: 10.1001/jamainternmed.2015.0324.
  4. Matthew Clark, “Deprescribing Medications,” Indian Health Service, undated.
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