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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] - health-system-embedded deprescribing for community-dwelling elderly, no better than usual care for preventing medically-treated falls at 18 months [44] - 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] - medication review to target polypharmacy through deprescribing is recommended as part of a comprehensive management plan for frail elderly [41,42,43] - 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

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  3. Paauw DA 11 Drugs You Should Seriously Consider Deprescribing: 2018 Update Medscape Oncology. November 5, 2018. https://www.medscape.com/slideshow/deprescribing-6009041
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  9. U.S. Deprescribing Research Network Resources for Clinicians https://deprescribingresearch.org/resources-2/resources-for-clinicians/
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  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
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  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
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  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
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  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
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