Deprescribing prescription drugs

What is deprescribing?

As an advocate for less medicine and better health, I love the latest healthcare trend of “deprescribing,” or cutting down the number of prescription drugs a patient is taking.

Dr. Aaron Carroll of Healthcare Triage explains the importance of deprescribing in this video:

Polypharmacy—taking multiple prescription drugs—has become much more common over the last couple of decades. There are more drugs than ever on the market, and the drug companies are spending billions of dollars to make sure we know all about them.

Related post: Bohemian Polypharmacy

The elderly are especially at risk. Not only are they more likely to be taking two or more prescription drugs (I’ve known patients taking 20 or more drugs!), their bodies are more vulnerable to bad side effects and drug interactions.

As Dr. Carroll says in the video,

Yet an increasing number of Americans—typically older ones with multiple chronic conditions—are taking drugs and supplements they don’t need, or so many of them that those substances are interacting with one another in harmful ways.

The vast majority of higher-quality studies summarized in a systematic review on polypharmacy—the taking of multiple medications—found an association with a bad health event, like a fall, hospitalization or death.

Are you taking too many prescription drugs?

Dr. Carroll also emphasizes that patients need to be part of the deprescribing process.

I found a great article on Reader’s Digest that can help: 10 signs you’re taking too many prescriptions

  1. You have access to good health care. That’s right! Having good health coverage and being able to see a physician frequently puts you at higher risk of being over-treated and over-medicated.
  2. You’re seeing several doctors. Doctors don’t necessarily know what each other is prescribing. Electronic health records help, but different doctors use different systems and they don’t talk to each other, either. Using several different pharmacies can also cause problems.
  3. You recently developed new symptoms. If you experience problems after starting a new medication, a bad drug interaction may be to blame. Let  your doctor know what’s happening.
  4. You struggle to keep up with dosing. Can’t remember what you took and when? That’s a red flag, for sure.
  5. You’re worried about addiction. Prescription opioid abuse has been making headlines for a few years now, but other addictive medications such as the anti-anxiety drugs Xanax and Ativan are also over-prescribed.
  6. Your mental health is suffering. Some medications can cause fatigue and interfere with sleep or appetite. Taking several meds only increases the risk of feeling tired and depressed.
  7. You’re constantly battling joint or muscle pain. Some meds, like statins, have pain as a side effect. Others can mess with your brain’s pain signals.
  8. You’re under increasing financial pressure. Have you noticed lately how incredibly expensive prescription drugs have become?
  9. You have trouble talking to your doctor. I’ve known many patients that would like to take fewer meds, but are afraid to speak to their doctors about it. They don’t want to question the doctor’s authority, or be a troublesome patient. Speak up!!
  10. You feel your meds are beyond your control. 

As I said, it’s usually the elderly that are at risk of taking too many medications and suffering the consequences.

If you have elderly relatives you help care for, ask them about their medications.

  • Do they know how many they are taking?
  • Do they know what each drug treats?
  • How long have they been taking each medication?
  • How many different doctors wrote the prescriptions?

Encourage them to speak with their doctors about whether all the medications are still necessary.

Doctors can be reluctant to deprescribe if the patient is doing OK and not having problems with their current medication list.

Sometimes the patient has to make the first move!

Sláinte,

Frugal Nurse

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