Polypharmacy is a prevalent problem, particularly among older patients who may be taking multiple medications, many of which have become unnecessary and potentially harmful. Deprescribing, or the process of paring back those medications, can be accomplished in four steps:
1. Conduct a “brown bag” review. Ask the patient to bring in all medications they are taking, even over-the-counter drugs or supplements, to get an accurate record.
2. Identify inappropriate, unnecessary, and harmful medications. With the patient, review the list to determine which medications are providing benefits and which are not. Ask the patient if there are any medications he or she would like to quit because of negative side effects or whether any medications have complex dosing regimens that could be simplified.
3. Decide with the patient when and how to stop selected medications. Patients may be resistant to stopping a medication because they’re concerned about their condition worsening or they don’t want to contradict the original prescriber. To get them on board, consider discontinuing one medication at a time or tapering medications if necessary. Also, assure patients you will closely monitor them for worsening conditions or withdrawal effects.
4. Regularly review medications. On at least an annual basis, take another look at the patient’s medication list in case they accumulate additional medications from other providers.
Adapted from “Deprescribing Unnecessary Medications: A Four-Part Process.”
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