Geoff Maly, M.D., MPH, Family Physician, Winding Waters Clinic.
As a family physician, I write dozens of prescriptions for pharmaceutical drugs every day. I have seen the positive outcomes from therapy with these medications. However, I have also seen many of the negative effects from these same medicines. The difference in outcome in many cases depends upon the individual. For some people, the risks associated with the medication outweigh the benefits. This is particularly true in older adults and in people on multiple medications, where side effects are magnified and benefit may be limited. These two groups are the primary targets for deprescribing. Deprescribing refers to a review of medications with the goal of reducing the number of medications to the most essential. This article will discuss the concept of deprescribing and identify some common medications that are often deprescribed.
If you watch television, you will see many commercials for new medications. The drug companies who buy these commercials want to sell their latest and greatest medication, many of which come with a steep price tag and minimal benefit compared to older, less expensive options. Furthermore, these medications often have a long list of side effects. This list is usually relegated to the fine print or rattled off with a rapid voice at the end of the commercial. However, this does not make the side effects any less real for patients who suffer from them.
In addition to side effects, medications can interact with one another to create secondary problems. Medications can also interact with over the counter drugs and sometimes foods. When the number of medications grows, so does the risk of adverse interactions. There is a medical term for when a patient is on a large number of medications: polypharmacy. Deprescribing is an attempt to counteract polypharmacy.
Deprescribing is especially important in adults age 65 and older. Side effects like dizziness, confusion and falls can be devastating as you age. The “Beers Criteria” is a list of medications developed by the American Geriatric Society to avoid in older adults. One study in 2015 showed that 29 percent of Medicare Beneficiaries received a medication that was on the Beers List. Some familiar medications on this list include:
Sedative-hypnotic drugs, like lorazepam and diazepam;
Proton pump inhibitors like omeprazole [Prilosec];
Antihistamines like diphenhydramine [Benadryl];
Diabetic medications especially sulfonylureas [e.g.Glipizide]; and
Non-steroidal anti-inflammatory medications like ibuprofen and naproxen.
Medications in older adults may also start to lose some of their benefit. For example, the benefits of statins and blood thinners generally decrease while the risks increase. It is our job as primary care providers to help individuals decide when the risks of continuing a medication outweigh the benefits.
Deprescribing should be done under the direction of your healthcare provider. Your pharmacist may also be able to help. A recently completed study titled the “D-Prescribe Trial” identified ways that pharmacists can help patients and physicians successfully deprescribe. The website deprescribe.org is an excellent resource. This website was started by a Canadian pharmacist to help patients and providers reduce or stop medications that may be harmful to their health or may not be needed anymore. The website has several charts that can be used to help stop medications, including many of those mentioned above.
While I hope you will not read this article and decide to stop all of your medications, I do hope it will help you have a conversation with your healthcare provider about your medication list or the medication list of a loved one. Sometimes less is more, even in medicine.
Mountain Medicine is edited by Ron Polk, and is a collaboration with Wallowa County healthcare practitioners.