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Pharmacoeconomic Corner: Deprescribing in the Elderly | Castellana
  • Deprescribing is the process of medication withdrawal, intentionally stopping a drug or reducing its dose because:
    • It is causing side effects
    • It is putting the patient at risk
    • Is no longer of benefit
  • Polypharmacy is considered as taking 8 or more medications, with or without identified adverse effects. Polypharmacy has as much or more morbidity and mortality than many diseases.
    • In 2000 it cost $85 billion and 106,000 lives vs. Diabetes Mellitus cost $91.8 billion and 224,000 lives.
  • Proven benefits of deprescribing:
    • Reduces polypharmacy
    • Reduces adverse effects
    • Improves quality of life
    • Reduces costs to the patient and the health system
  • Key occasions to deprescribe:
    • AHA Visit
    • Post-discharge Reconciliation
    • Emergency Room Visit
    • To improve medication adherence measures, at the beginning of the year, before the measure is activated by the second dispatch, review and deprescribe what the patient should not take.
  • The process of medication reconciliation is an opportune occasion to deprescribe. To complete this process, your office staff may instruct the patient to bring all medications they use (prescription, OTC, natural supplements, etc.).
  • When medication reconciliation, it is important to take into consideration the following characteristics of the patient:
    • Age (Evaluate elderly using medications from the Beers List)
    • Comorbidities
    • Adherence
    • Social support
    • Cognitive function

Key Questions for Medication Reconciliation

 Is there an active diagnosis for this medication?
 Is this medicine used to treat side effects of another medication?
 Is it the correct dose?
 Could abnormal lab results be drug effect?
 Is the medicine really helping you or is there no longer any benefit in treating your condition?
 Are there adherence barriers due to the cost or plan coverage?
 Could the falls you have be caused by the medication?
 Is insomnia a side effect of the medication?
 Is drowsiness caused by the medication?
 Is anorexia caused by the medication?
 Is weight gain or loss the effect of the drug?
 Does the patient have good adherence to therapy?

Strategies with the Patient to Deprescribe

  • If your doctor says it’s possible, would you agree to stop one or more of your medications?
  • I want both of us to work together to reduce your medications.
  • In this project to reduce your medicines I will not stop prescribing what you need
  • Which of your medicines do you really need?
  • Which drug do you want us to focus on first?
  • In terms of health what would make you feel better and more independent?
  • That medicine can take many years or decades to give you benefits, better focus on the medicines that can benefit you now, the ones that make you feel better and maintain your function and independence.
  • Let’s avoid medicines that can cause side effects.
  • Let’s avoid medicines that increase the risk of falls.

Remember to complete the following steps when deprescribing:

  1. Educate the patient about the medications they should discontinue and the method of safely disposing of medications at home.
  2. Update the list of medicines in the patient’s record.
  3. Write on the prescription the medication to be discontinued to offer instruction to the pharmacy and avoid dispensing refills of medications that the patient should not continue taking.

By Dr. José R. Muñiz Meléndez, MD, Geriatrician
Castellana (E) Medical Director