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medication deprescribing

The process of weaning patients from inappropriate medications or unnecessary medications. Notes: - pharmacist-led educational intervention successful in deprescribing inappropriate medications; however. only 1/4 of eligible patients agreed to participate [4] - deprescribing may reduce risk for dementia [5] - incident dementia diagnosis may be an opportunity to reduce polypharmacy by deprescribing medications inappropriate for the elderly with risk of further impairing cognition [35] (see Beer's criteria) - pharmacist-led deprescribing led to more medications discontinued & more medications added, resulting in a non-signifivant reduction in medication complexity but not overall medication count [38] - opioids may present a deprescribing challenge (see opioid deprescribing) - deprescribing acetylcholinesterase inhibitors in nursing home residents with advanced dementia not associated with negative outcomes [8] - deprescribing may reduce risk for falls, disability & death [6] - cognitive-behavioral therapy during antidepressant taper is as effective as continuing antidepressants [25] - most elderly are amenable to deprescribing [6,24,26] - non-whites with HFpEF may be less amenable medication deprescribing [26] - deprescribing with little effect on time to first emergency department visit, hospital readmission or death in hospitalized elderly [39] - deprescribing in hospitalized elderly discharged to postacute care facility - vitamins, supplements, laxatives, antihypertensives, anticoagulants, hypoglycemics & proton-pump inhibitors top cancidates in Shed-MEDS trial [34] - the U.S. Deprescribing Research Network website [9] has guidelines, algorithms, & videos for deprescribing of - proton pump inhibitors [10] - antipsychotics (see deprescribing antipsychotics) [11] - cholinesterase inhibitors & memantine [12] - hypoglycemic agents (antihyperglycemics) [13] - benzodiazepines [14] - multiple options for deprescribing from Medscape - deprescribing antidiabetic drugs in the elderly [17] - deprescribing metformin in frail elderly [18] - deprescribing bisphosphonates [19] - deprescribing SSRI in elderly [20] - deprescribing statins in elderly [21] (also see statin deprescribing) - deprescribing Alzheimer agents [22] - deprescribing proton pump inhibitors [23] - deprescribing benzodiazepines - Deprescribing.org has developed deprescribing guidelines & algorithms [31] - deprescribing proton pump inhibitors [31] - deprescribing antidiabetic drugs [31] - deprescribing antipsychotics [31] - deprescribing sedative/hypnotics including benzodiazepines [31] - deprescribing Alzheimer agents (cholinesterase inhibitors & memantine) [31] - deprescribing proton-pump inhibitors in ambulatory patients [32] - deprescribing psychotropic drugs in nursing home residents with dementia [27] - recognition that psychosis, agitation & difficult behavior in the elderly is best managed by non-pharmaceutical interventions - clear extrinsic incentive necessary - collaboration, communication, routines, & systematic procedures needed - lack of resources & qualifications, concern about symptom relapse, & staff tolerance of drug adverse events need to be overcome [27] - deprescribing antihypertensives in nursing home residents may be associated with 12-16% lower likelihood of 12 week progression of cognitive impairment [40] - attitudes toward deprescribing among older adults with dementia [29] - patient & provider perspectives on deprescribing proton pump inhibitors [30] - an electronic decision support tool (MedSafer Tool) improved deprescribing in hospitalized elderly but did not change frequency of adverse medication effects [28] - review of randomized controlled trials [15]

Related

Beers criteria inappropriate prescription

Specific

antidepressant deprescribing antimuscarinic deprescribing; anticholinergic deprescribing antipsychotic deprescribing deprescribing proton-pump inhibitor (PPI) discontinuation of chronic benzodiazepine use; benzodiazepine deprescribing opioid deprescribing statin deprescribing

General

discontinuation of therapy medication management

References

  1. Endsley S Deprescribing Unnecessary Medications: A Four-Part Process. Fam Pract Manag. 2018;25(3):28-32 PMID: 29989773 - Medscape. https://www.medscape.com/viewarticle/896726
  2. Farrell B, Pottie K, Thompson W et al Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline. Can Fam Physician. 2017 May;63(5):354-364. PMID: 28500192 Free PMC Article
  3. Paauw DA 11 Drugs You Should Seriously Consider Deprescribing: 2018 Update Medscape Oncology. November 5, 2018. https://www.medscape.com/slideshow/deprescribing-6009041
  4. Martin P, Tamblyn R, Benedetti A, Ahmed S, Tannenbaum C. Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: The D-PRESCRIBE randomized clinical trial. JAMA 2018 Nov 13; 320:1889. PMID: 30422193 https://jamanetwork.com/journals/jama/article-abstract/2714531
  5. George J Deprescribing to Reduce Dementia - Causal link still elusive, but anticholinergic drugs may be a modifiable dementia risk factor. MedPage Today. June 24, 2019 https://www.medpagetoday.com/neurology/dementia/80665 - Coupland CAC, Hill T, Dening T et al Anticholinergic Drug Exposure and the Risk of Dementia. A Nested Case-Control Study. JAMA Intern Med. Published online June 24, 2019. PMID: 31233095 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353 - Khan NF, Bateman BT, LandonKhan JE et al Association of Opioid Overdose With Opioid Prescriptions to Family Members. JAMA Intern Med. Published online June 24, 2019. PMID: 31233088 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736355
  6. Reeve E, Low LF, Hilmer SN. Attitudes of older adults and caregivers in Australia toward deprescribing. J Am Geriatr Soc 2019 Jun; 67:1204. PMID: 30756387 https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.15804
  7. Warner-Maron I Deprescribing and the Impact on Recruitment and Retention. Annals of Long-Term Care. Feb 27, 2020 https://www.managedhealthcareconnect.com/content/deprescribing-and-impact-recruitment-and-retention - Goyal P, Anderson TS, Bernacki GM, et al. Physician Perspectives on Deprescribing Cardiovascular Medications for Older Adults. J Am Geriatr Soc. 2020;68(1):78-86 PMID: 31509233
  8. Niznik JD, Zhao X, He M et al. Risk for health events after deprescribing acetylcholinesterase inhibitors in nursing home residents with severe dementia. J Am Geriatr Soc 2020 Apr; 68:699-707 PMID: 31769507 https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16241
  9. U.S. Deprescribing Research Network Resources for Clinicians https://deprescribingresearch.org/resources-2/resources-for-clinicians/
  10. Farrell B et al Deprescribing proton pump inhibitors. Evidence-based clinical practice guideline Canadian Family Physician May 2017, 63 (5) 354-364; PMID: 28500192 PMCID: PMC5429051 Free PMC article https://www.cfp.ca/content/63/5/354
  11. Bjerre LM et al Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia. Evidence-based clinical practice guideline. Canadian Family Physician Jan 2018, 64 (1) 17-27 PMID: 29358245 PMCID: PMC5962971 Free PMC article https://www.cfp.ca/content/64/1/17
  12. University of Sydney Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/deprescribing-guideline.pdf - University of Sydney Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine: Recommendations. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/deprescribing-recommendations.pdf
  13. Farrell B et al Deprescribing antihyperglycemic agents in older persons. Evidence-based clinical practice guideline. Canadian Family Physician Nov 2017, 63 (11) 832-843 PMID: 29138153 PMCID: PMC5685444 Free PMC article https://www.cfp.ca/content/63/11/832
  14. Pottie K, Thompson W, Davies S et al Deprescribing benzodiazepine receptor agonists. Canadian Family Physician May 2018, 64 (5) 339-351 PMID: 29760253 PMCID: PMC5951648 Free PMC article http://www.cfp.ca/content/64/5/339
  15. Dills H, Shah K, Messinger-Rapport B et al Deprescribing Medications for Chronic Diseases Management in Primary Care Settings: A Systematic Review of Randomized Controlled Trials. J Am Med Dir Assoc. 2018 Nov;19(11):923-935.e2 PMID: 30108032 https://higherlogicdownload.s3-external-1.amazonaws.com/AMERICANGERIATRICS/844922fc-f4fd-4281-8b92-c444407ae9f5_file.pdf
  16. Holmes HM, Haley DC, Alexander GC, Sachs GA Reconsidering Medication Appropriateness for Patients Late in Life. Arch Intern Med. 2006 Mar 27;166(6):605-9 PMID: 16567597
  17. Vega CP Stop or Switch the Antidiabetic Drug? Medscape - Aug 14, 2019. https://www.medscape.com/viewarticle/916642 - Vega CP Deprescribing Antidiabetic Drugs: The Crowdsourced Opinion. Medscape - Oct 16, 2019. https://www.medscape.com/viewarticle/919644
  18. Vega CP Is It the Right Time to Deprescribe This Frail Patient's Metformin? Medscape - May 20, 2021. https://www.medscape.com/viewarticle/951314
  19. Vega CP Deprescribing Bisphosphonates: The Crowdsourced Opinion. Medscape - Jul 24, 2019. https://www.medscape.com/viewarticle/915729 - Vega CP When to Stop the Bisphosphonate. Medscape - May 31, 2019. https://www.medscape.com/viewarticle/913559
  20. Vega CP Cite this: Deprescribing SSRIs: The Crowdsourced Response. Medscape - May 03, 2019. https://www.medscape.com/viewarticle/912385 - Vega CP Cases in Deprescribing: When to Stop the SSRI. Medscape - Mar 26, 2019 https://www.medscape.com/viewarticle/910669
  21. Vega CP Cases in Deprescribing: When to Get Rid of the Statin. Medscape - Jan 31, 2019 https://www.medscape.com/viewarticle/908235 - Vega CP Statin Deprescribing Follow-up: How You Voted. Medscape - Feb 26, 2019. https://www.medscape.com/viewarticle/909424
  22. Vega CP Are Dementia Drugs Serving This Patient Well? Medscape - Jan 08, 2020. https://www.medscape.com/viewarticle/923343 - Vega CP Deprescribing Alzheimer's Drugs: The Crowdsourced Opinion Medscape - Feb 24, 2020. https://www.medscape.com/viewarticle/925445
  23. Vega CP Continue, Stop, or Taper the PPI? Medscape - Oct 25, 2019. https://www.medscape.com/viewarticle/920314_2 - Vega CP Another Reason to Stop the PPI: Clinician Debate Medscape - Oct 13, 2020. https://www.medscape.com/viewarticle/938726
  24. Lundby C, Glans P, Simonsen T et al Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents. J Am Geriatr Soc 2021. 69(6):1508-1518 June. first Published Feb 17 PMID: 33598916 https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.17054
  25. Breedvelt JJF et al. Continuation of antidepressants vs sequential psychological interventions to prevent relapse in depression. JAMA Psychiatry 2021 May 19; [e-pub]. PMID: 34009273 PMCID: PMC8135055 (available on 2022-05-19) https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2780290
  26. Navid P, Nguyen L, Jaber D et al Attitudes toward deprescribing among adults with heart failure with preserved ejection fraction. J Am Geriatr Soc 2021. 69(7):1948-1955 July PMID: 33978239 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17204
  27. Moth AE, Holmkjaer P, Holm A et al What Makes Deprescription of Psychotropic Drugs in Nursing Home Residents with Dementia so Challenging? A Qualitative Systematic Review of Barriers and Facilitators. Drugs Aging 2021. July 7 PMID: 34231182 https://link.springer.com/article/10.1007/s40266-021-00875-1 - Harrison SL, Cations M, Jessop T, Hilmer SN, Sawan M, Brodaty H. Approaches to Deprescribing Psychotropic Medications for Changed Behaviours in Long-Term Care Residents Living with Dementia. Drugs Aging. 2019 Feb;36(2):125-136. PMID: 30535930 Review.
  28. McDonald EG, Wu PE, Rashidi B et al. The MedSafer study - Electronic decision support for deprescribing in hospitalized older adults: A cluster randomized clinical trial. JAMA Intern Med 2022 Jan 18; [e-pub] PMID: 35040926 PMCID: PMC8767487 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2788297
  29. Matthews S Deprescribing Among Older Adults With Dementia. Annals of Long-Term Care. 2022. March 10. https://www.hmpgloballearningnetwork.com/site/altc/news/deprescribing-among-older-adults-dementia - Growdon ME, Espejo E, Jing B et al. Attitudes toward deprescribing among older adults with dementia in the United States. J Am Geriatr Soc. 2022. March 10. PMID: 35266141
  30. Ikeji C, Williams A, Hennawi G, Brandt NJ. Patient and Provider Perspectives on Deprescribing Proton Pump Inhibitors. J Gerontol Nurs. 2019 Oct 1;45(10):9-17 PMID: 31560071
  31. Deprescribing.org Deprescribing Guidelines and Algorithms. https://deprescribing.org/resources/deprescribing-guidelines-algorithms/
  32. Targownik LE et al. AGA clinical practice update on de-prescribing of proton pump inhibitors: Expert review. Gastroenterology 2022 Apr; 162:1334. PMID: 35183361 https://www.gastrojournal.org/article/S0016-5085(21)04083-X/fulltext
  33. Reeve J, Maden M, Hill R et al. Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis. Health Technol Assess. 2022;26(32):1-148 PMID: 35894932 PMCID: PMC9376985 Free PMC article https://psnet.ahrq.gov/issue/deprescribing-medicines-older-people-living-multimorbidity-and-polypharmacy-tailor-evidence
  34. Vasilevskis EE et al. Deprescribing medications among older adults from end of hospitalization through postacute care: A Shed-MEDS randomized clinical trial. JAMA Intern Med 2023 Feb 6; [e-pub]. PMID: 36745422 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2800886
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  36. Rubin R Deciding When It's Better to Deprescribe Medicines Than to Continue Them. JAMA. Published online November 29, 2023 PMID: 38019481 https://jamanetwork.com/journals/jama/fullarticle/2812506
  37. Silva Almodovar A, Keller MS, Lee J et al Deprescribing medications among patients with multiple prescribers: A socioecological model. J Am Geriatr Soc. 2024 Mar;72(3):660-669. PMID: 37943070 Free PMC article. https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18667
  38. Green AR, Quiles R, Daddato AE et al Pharmacist-led telehealth deprescribing for people living with dementia and polypharmacy in primary care: A pilot study. J Am Ger Soc 2024 72(7):1973-1984 Epub: March 15 PMID: 38488757 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18867 - Pickering AN, Anderson TS Deprescribing for people living with dementia: ALIGNing interventions and outcomes. J Am Ger Soc 2024 72(7):1949-1951 Epub: May 15 PMID: 38751095 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18946
  39. Lee JW, Hollingsworth EK, Shah AS, et al Emergency department visits and hospital readmissions after a deprescribing intervention among hospitalized older adults. J Am Ger Soc 2024 72(7):2038-2047 Epub: May 9 PMID: 38725307 https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18945
  40. Jing B, Liu X, Graham LA et al Deprescribing of Antihypertensive Medications and Cognitive Function in Nursing Home Residents. JAMA Intern Med. 2024 Sep 23:e244851. PMID: 39312220