Deprescribing

Polypharmacy is associated with increased risks of adverse events, drug interactions, falls, hospitalization, cognitive deficits,[better source needed] and mortality.

[11] Thus, optimizing medication through targeted deprescribing is a vital part of managing chronic conditions, avoiding adverse effects and improving outcomes.

[17] Early evidence suggested that deprescribing may reduce premature death, leading to calls to undertake a double-blind study.

[18] It found no change in mortality[19] and that, if implemented in all residential aged care facilities across Australia, it could save up to $16 million annually.

[20] Deprescribing medications may improve patient function, generate a higher quality of life, and reduce bothersome signs and symptoms.

In these cases, tools and guidelines like the Beers Criteria and STOPP/START could be used safely by clinicians, but not all patients might benefit from stopping their medication.

Further factors that can help clinicians tailor their decisions to the individual are: access to detailed data on the people in their care (including their backgrounds and personal medical goals), discussing plans to stop a medicine already when it is first prescribed, and a good relationship that involves mutual trust and regular discussions on progress.

Furthermore, longer appointments for prescribing and deprescribing would allow time to explain the process, explore related concerns, and support making the right decisions.

Patients and informal carers should be involved in decisions, and trusted relationships should be built up with professionals allowing continuity of care.

Prescribers should be aware of which medications usually require tapering (such as corticosteroids and benzodiazepines) and which can be safely stopped suddenly (such as antibiotics and nonsteroidal anti-inflammatory drugs).

It is recommended that prescribers frequently monitor "relevant signs, symptom, laboratory or diagnostic tests that were the original indications for starting the medication," as well as for potential withdrawal effects.

[29] It prompts clinicians to consider if it is (1) an inappropriate prescription, (2) adverse effects or interactions that outweigh symptomatic effects or potential future benefits, (3) drugs taken for symptom relief but the symptoms are stable, and (4) drug intended to prevent future severe events but the potential benefit is unlikely to be realized due to limited life expectancy.

[30] The ERASE mnemonic stands for "evaluate diagnostic parameters," "resolved conditions," "ageing normally," "select targets," and "eliminate."

[35] RxFiles, an academic detailing group based in Saskatchewan, Canada, has developed a tool to help long-term care providers identify potentially inappropriate medications in their residents.