DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
BACKGROUND
Definition
- Planned and supervised process of dose reduction or stopping medication that may no longer benefit the patient or cause more harm than good
- Benefits can include improved quality of life and reduced pill burden for patient
Patient groups
- Patient groups that may benefit:
- end of life (prognosis of ≤3 months)
- multi-morbidity (presence of ≥2 long-term health conditions)
- frail, elderly patients
- declining renal or hepatic function
Who actions?
- Only a prescriber undertakes deprescribing
- prescribers are accountable for the effects of deprescribing and prescribing a medication
- involve patients in decisions regarding initiation and/or cessation of medicines including potential side effects and intended outcomes of treatment
ASSESSMENT
- For all medication consider the following
- what are the benefits of the medication?
- are the expected benefits important to the patient’s goals?
- is the benefit likely to be realised given the short life expectancy?
- is the medication’s target symptom or disease still applicable?
- does the medication manage symptoms or prevent ongoing progressive disease?
HOW TO DEPRESCRIBE
- Take a comprehensive medication history and check adherence
- if a medication is never or rarely taken this makes stopping easier
- Identify potentially inappropriate medications and whether these medications can be stopped
- Plan withdrawal regimen
- can the medication be stopped abruptly, or does it need to be tapered over time?
- in general, medications should be reduced or stopped one at a time. However, in last days of life it can be appropriate to stop multiple medications abruptly
- Document in medical notes the rationale for deprescribing and discussions undertaken with patient or their carer
- Check for benefit or harm after each medication has been reduced or stopped
- If a medication needs to continue with patient unable to take an oral medication, consider an alternative route such as transdermal or subcutaneous
Common medications to consider deprescribing
- Antiplatelet agents/anticoagulants
- Statins
- NSAIDS (especially in combination with a diuretic)
- Cardiovascular drugs (especially ACEI and in patients with renal impairment)
- Hypoglycaemic agents
- Bisphosphonates
Helpful tool
- STOPP/START tool: identifies high risk problems in prescribing for older people, both in terms of reducing medicine burden and adding in potentially beneficial therapy