A Practical Approach to De-Prescribing: A Pharmacist’s Perspective
The continued rise of prescription drug costs has become an enormous financial burden for many Americans. De-prescribing unnecessary medications in combination with positive lifestyle changes not only reduces the financial burden of the patient but also of the nation’s healthcare system.
In the age of modern medicine, many patients are on medications longer than necessary, and our culture frequently assumes that ‘more is better.’ Many physicians are uncomfortable with de-prescribing and have a fear of losing patients. The lack of evidence on de-prescribing further discourages physicians to reduce the number of medications their patients are on.
Guideline recommendations are in constant flux and new evidence continues to challenge widely accepted recommendations of the past. The appropriateness of patients’ medications requires ongoing review to ensure they are continuing to provide benefit and at the very least are not posing potential harm. Pharmacists can be valuable allies when attempting to identify potential opportunities to reduce a patient’s medication burden. Pharmacists can also assist in developing safe and structured de-prescribing plans to minimize unwanted withdrawal side effects.
In most cases, positive lifestyle changes can allow patients to significantly reduce their number of necessary medications. Additionally, some patients may be candidates for de-prescribing even without making significant lifestyle changes. This will be an in-depth discussion of de-prescribing: what it is, when to consider it, and how to do it safely. We will discuss how to de-prescribe some common medications and the financial implications. We will also discuss the risks of not de-prescribing: adverse drug events, side effect unawareness, drug interactions, and chronic medication overuse.
- Define de-prescribing and identify situations in which to consider it
- Discuss the contiued need to review patients’ medications for appropriateness and benefit
- Outline how to de-prescribe some common medications