Deprescribing

Deprescribing is the process of intentionally stopping a medication or reducing its dose to improve the person's health or reduce the risk of adverse side effects. De-prescribing is usually done because the drug may be causing harm, may no longer be helping the patient, or may be inappropriate for the individual patient's current situation. De-prescribing is the opposite of prescribing a drug. It can help correct polypharmacy and prescription cascade.

Deprescribing is often done with people who have multiple chronic conditions, for elderly people, and for people who have a limited life expectancy. In all of these situations, certain medications may contribute to an increased risk of adverse events, and people may benefit from a reduction in the amount of medication taken. The goal of deprescribing is to reduce medication burden and harm, while maintaining or improving quality of life. "Simply because a patient has tolerated a therapy for a long duration does not mean that it remains an appropriate treatment. Thoughtful review of a patient’s medication regimen in the context of any changes in medical status and potential future benefits should occur regularly, and those agents that may no longer be necessary should be considered for a trial of medication discontinuation."

The process of deprescribing can be planned and supervised by health care professionals.

Older people are the heaviest users of medications, and frequently take five or more medications (polypharmacy). Polypharmacy is associated with increased risks of adverse events, drug interactions, falls, hospitalization, cognitive deficits, and mortality. Thus, optimizing medication through targeted deprescribing is a vital part of managing chronic conditions, avoiding adverse effects and improving outcomes.

Deprescribing is a feasible and safe intervention. Deprescribing results in fewer medications with no significant changes in health outcomes. A systematic review of deprescribing studies for a wide range of medications, including diuretics, blood pressure medication, sedatives, antidepressants, benzodiazepines and nitrates, concluded that adverse effects of deprescribing were rare.

By deprescribing medications, prescribers are often able to improve patient function, generate a higher quality of life, and reduce bothersome signs and symptoms. Deprescribing has been linked to lower fall risk and global improvements in health. Targeted deprescribing can improve cognition in the elderly.

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