Deprescribing is the planned and supervised process of reducing or stopping medications that may no longer be beneficial or may be causing harm.
Its primary goal is to manage polypharmacy, reduce medication burden, and improve a patient’s overall quality of life.
It forms an essential part of good prescribing, especially for older adults, those with polypharmacy, frailty, limited life expectancy, or changing health goals.
As people age or their health status changes, medications that were once helpful can become problematic.
Key reasons for deprescribing:
Preventing Harm: Reducing the risk of adverse drug reactions, falls, and cognitive impairment.
Addressing Redundancy: Identifying medications continued indefinitely without a clear current indication.
Aligning with Goals: Ensuring treatment matches a patient’s current values, especially in palliative or end-of-life care.
Cost Savings: Reducing pharmacy-related expenses for both the patient and the healthcare system.
Deprescribing is not simply stopping a medication, it is a clinical practice that follows a systematic framework:
Comprehensive review history of all prescription and over-the-counter medications.
Determine which drugs are potentially inappropriate or lack a clear benefit.
Assess Eligibility: Evaluate the risks of stopping versus continuing, considering life expectancy and treatment goals.
Decide which medication(s) to stop first and create a supervised tapering schedule.
Regularly check for withdrawal symptoms or the return of the original condition.
Abruptly stopping certain drugs (like antidepressants or beta-blockers) can cause serious withdrawal effects.
The aim is to lower medication burden, reduce adverse drug events (ADEs), improve quality of life, and optimize outcomes while minimizing risks like withdrawal symptoms.
Many people, particularly seniors, accumulate medications over time for chronic conditions. Some become unnecessary, ineffective, or risky due to:
Resolved underlying conditions Changed goals of care Drug interactions or side effects, such as falls, cognitive issues, gastrointestinal problems. Limited time-to-benefit for preventive drugs in those with shorter life expectancy
Evidence shows deprescribing safely reduces the number of medications and potentially inappropriate prescriptions, with low rates of serious withdrawal events.
Benefits of describing can include fewer falls, better cognition or function, lower costs, and sometimes improved quality of life or even reduced mortality in select cases.
Clinical outcomes like hospitalizations vary, but the process is generally considered safe.
Examples of medications often considered for deprescribing;
Proton pump inhibitors (PPIs): After 4+ weeks if symptoms resolved; try on-demand or lower dose.
Benzodiazepines: High risk for dependence, falls, cognitive issues; taper slowly with non-drug alternatives.
Antihypertensives: In frail patients or those with low blood pressure
Antidepressants: After sustained remission (e.g., 6–12 months); gradual taper to avoid withdrawal.
Opioids, NSAIDs, antipsychotics, statins, or preventive meds: When harms exceed benefits.
Withdrawal or rebound symptoms that are common with some drugs (e.g., rebound acid with PPIs, anxiety/insomnia with benzodiazethines-can be mitigated by slow tapering (e.g., 10–25% reductions every 2–4 weeks or slower), using temporary alternatives, and close monitoring.
Deprescribing is not abrupt cessation without supervision—it’s collaborative and patient-centered with shared decision making.
Success rates improve with patient education and support.
Deprescribing is highly individualized—factors like age, comorbidities, life expectancy, and personal values guide decisions.