Question: What is “Deprescribing?” Why does my healthcare provider want me to stop by medication?
When you think of a pharmacist, what first comes to mind? Is it learning about a new medication? Is it asking for advice about which over-the-counter medicine you should use? You may be surprised when that a pharmacist can talk to you about stopping a medication.
*record skips* Wait a minute. Aren’t pharmacists supposed to be “pill pushers?”
Though your pharmacist can be a great source of information about which medications can help treat your health conditions, another part of their job is to make sure your medications are the best fit for you and your health goals. That can mean many things like when to start or switch to a new medication, when to increase your dose, or the opposite- when to stop or reduce the dose of a medication. Your health providers may refer to this as “deprescribing.”
Deprescribing.org provides the following definition: “Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit. Deprescribing is part of good prescribing – backing off when doses are too high, or stopping medications that are no longer needed.”
The core concept is this: medications that were good in the past, might not be the best choice now. A pharmacist’s goal is to make sure your medication regimen has the greatest benefit to you with the lowest long-term risks, which means revisiting each drug periodically over time to make sure it is still the best choice.
What are some medications that might be deprescribed?
The short answer is this: Any medication could potentially be a candidate to be deprescribed depending on the goals and wishes you have discussed with your provider. There are certain medications that your pharmacist may be likely to recommend stopping, particularly as we get older and the way our body responds to medications changes. Here are a few examples:
- Medicines used to reduce stomach acid
- Certain diabetes medications
- Sleep aids
An important caveat!
Deprescribing doesn’t mean taking away medications that you want to continue. The second core concept, which applies to all areas of your health, is that the decision to “deprescribe” is shared between you and your health care provider. Pharmacists and other providers can be a valuable source of information, but the decision needs to be shared among the health care team for the best results. Who is the V.I.P of that team? YOU!
When you are gathering information to make a decision regarding your health care, it may be helpful to ask yourself: are you SURE?
|Sure of myself||Do you feel sure about the best choice for you?|
|Understand information||Do you know the benefits and risks of each option?|
|Risk-benefit ratio||Are you clear about which benefits and risks matter most to you?|
|Encouragement||Do you have enough support and advice to make a choice?|
The SURE Test ©2008 O’Connor & Légaré.
If you’re interested in stopping a medication, whether because of a side effect or to reduce the number of pills you take, your pharmacist can be a valuable source of information and support. It is important to always consult with your pharmacist or doctor before abruptly stopping a medication. Certain medications may need to be slowly reduced before stopping to prevent negative health effects, which can be severe. Even if a medication you are taking is one that may be deprescribed for some people, it may still be the right fit for your health conditions. Contact your healthcare provider if you would like to discuss further
Prepared by Sam Miller PharmD Candidate 2020
- Farrell B, Black C, Thompson W, McCarthy L, Rojas-Fernandez C, Lochnan H, et al. Deprescribing antihyperglycemic agents in older persons. Evidence-based clinical practice guideline. Can Fam Physician 2017;63:832-43 (Eng), e452-65 (Fr).
- Farrell B, Pottie K, Thompson W, Boghossian T, Pizzola L, Rashid FJ, et al. Deprescribing proton pump inhibitors. Evidence-based clinical practice guideline. Can Fam Physician 2017;63:354-64 (Eng), e253-65 (Fr).
- Légaré F, Kearing S, Clay K, et al. Are you SURE?: Assessing patient decisional conflict with a 4-item screening test. Can Fam Physician. 2010;56(8):e308–e314.
- Pottie K, Thompson W, Davies S, Grenier J, Sadowski C, Welch V, Holbrook A, Boyd C, Swenson JR, Ma A, Farrell B (2016). Evidence-based clinical practice guideline for deprescribing benzodiazepine receptor agonists. Can Fam Physician 2018;64:339-51 (Eng), e209-24 (Fr)
- What is Deprescribing? Deprescribing.org. https://deprescribing.org/what-is-deprescribing/. Accessed January 30, 2020.