How deprescribing helps you

An elderly woman called up her doctor in tears. When the doctor got on the phone, she asked him, “Is there something you’re not telling me? Do I need to review my will?”

Her doctor exclaimed, “No, not at all! Why?”

She wailed, “You told me I needed to take this medicine for the rest of my life. When I picked up my prescription today, the bottle said, No Refills!”

This is an old joke, but taking your medications appropriately can be a very serious challenge.

Medications are by far the most common treatment for most medical conditions. Before COVID, whether at a doctor’s office or at an Urgent Care Center, over 70% of physician visits end in a prescription.

That’s because doctors want to treat you with something and patients expect something to be done. And that something is often a prescription medicine. As people age, they pick up more and more health conditions and drugs to treat them.

As we age, our body becomes slower in detoxifying and removing medications of all types. This means that over time, our body retains our medicines longer, which increases the “dose” we take. It often takes a crisis or an adverse event such as a fall or hospitalization to jumpstart the conversation to reevaluate medicines and their doses.

Evaluating and making sure that you are taking only the medications you truly need at the best doses for you is called deprescribing. It involves balancing the potential for adverse outcomes with the potential benefit of your medicines.

Unfortunately, doctors are not always proactive or enthusiastic about deprescribing.

One reason is that our health care system is geared towards starting medications, not stopping them. Most guidelines that describe the optimal care for a particular condition include recommendations for initiating medications but not discontinuing them.

Another reason is concern about interfering with what another doctor put in place.

Patient reluctance is another barrier to deprescribing. Patients or their families may feel that decreasing their medicine decreases their level of care or that their doctor is “writing them off” or abandoning them.

A third reason doctors can be reluctant to initiate a discussion about reducing medications is lack of time. Introducing the concept and discussing how best to do it doesn’t fit inside a typical doctor visit.

There are 4 steps to deprescribing:

Step 1: Identify drugs that could be adjusted or stopped, focusing on medications known to be affected by changes in our bodies as we age. Doses easily tolerated 10-15 years ago should be reevaluated and possibly adjusted.

Step 2: Engage the patient, family, and other healthcare providers in the process.

Step 3:Develop a plan for tapering or discontinuation.

Step 4:Monitor for and document any adverse outcomes and benefits.

5 ways to take only the medicines you truly need

1. Take the initiative.

If you are over 70 years old and take five or more prescription medications, schedule a “deprescribing” conversation with your doctor. Let the office know ahead of time that you are interested in evaluating your medication list, reducing or eliminating anything that is no longer necessary.

2. Avoid duplication.

Whenever you are prescribed a new medicine, ask how it will affect your other medications. Is it being ADDED to the rest of your pills, or does it REPLACE one of them? If it is supposed to replace a medicine, which one do you stop? This way, when the new one arrives in the mail a week later, you make the switch instead of piling on another drug you don’t need anymore.

3. Don't stop medications "cold turkey."

The higher the dose and the longer you have been on it, the more slowly certain medicines should be tapered down or discontinued. With some drugs, stopping abruptly or running out of them can put you in the hospital for several days. It's best to plan out exactly how to transition down from your current dose of prescription medicine with your doctor's input.

4. Be a "Squeaky Wheel."

When you notice a new problem, ask yourself, “Could this be from one of my medicines?” If you started a new medication recently, inform your doctor of any new symptoms, in case it needs to be adjusted or stopped.

5. Keep a List.

Keep an updated list of everything you take, including what you take it for and any allergies or adverse reactions to medications. Bringing it to all your medical and dental appointments helps prevent getting medications that can interfere or interact poorly with each other.

Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog TheMedicationInsider.com. 2021 Louise Achey