What Was Good Then May Not Be Now
It is becoming more and more common for people to take five or more medications. The more medications a person takes, the greater their risk for negative health outcomes, such as reduced quality of life, increased side effects, drug interactions, physical or mental impairment, falls, addiction, hospitalization or even, death. The use of some medications, especially as people age or become sicker, can do more harm than good. There is also greater risk of taking them incorrectly—the more medications, the more confusion.
Taking five medications or more is called polypharmacy, which increased nearly 63% among people over 65 years between 1999 and 2012 according to a Harvard study reported in JAMA (Journal of American Medical Association) in November 2015. Given the concerns about polypharmacy, medical professionals are taking a growing interest in carefully guiding their patients through a process of deprescribing.
Easy to Start, Hard to Stop
Clinical guidelines for how and when to start a medication are readily available to clinicians. Historically, these guidelines have not included instructions on how to stop medications. This may be one of the reasons that the number of people who take 5 or more medications is on the rise. It may be possible to shorten your medication list through a careful process of deprescribing developed and managed closely by your provider.
Deprescribing refers to a careful medication review and the process of reducing or stopping medication(s) that no longer provide benefit or may be causing harm. Besides reducing some of the above risks, deprescribing can help patients save money and become more compliant with taking their medications as prescribed.
“Frequently, a medication is started to see whether it will help with certain symptoms—almost like a diagnostic test—but then the medication is never stopped,” said clinical scientist Barbara Farrell, PharmD, as reported by Medscape. Farrell is the co-developer of a website (deprescribing.org) that strives to raise awareness about deprescribing and is cofounder of the Canadian Deprescribing Network. She and her colleagues have developed guidelines for deprescribing among the elderly, who tend to have more medical conditions, and as a result, tend to take more medications. The guidelines apply to four classes of drugs and they are developing additional guidelines for other commonly prescribed medications. While Farrell’s work is focused on the elderly, it can be useful for providers helping their patients of any age arrive at safe and appropriate medication regimes.
A Case In Point
Judith* has diabetes, vascular disease, high blood pressure and high cholesterol. She enrolled in KnovaSolutions when her doctor retired and needed help finding a new one. When Judith said she sometimes felt dizzy, was often fatigued, and was tired of taking so many pills, her KnovaSolutions nurse and pharmacist performed a medication review and discussed their concerns with her. Judith admitted she couldn’t remember the reasons for starting several of her medications. Along with her list of 17 medications (and a few supplements), Judith took a list of questions that she and her nurse had prepared to her first appointment with the new provider. The new doctor agreed that change would be beneficial.
Judith’s story is a good example of “what was good then may not be now.” After her doctor’s review and a transition period, Judith stopped taking five medications, reduced the dose of two, substituted one medication with an over-the-counter (OTC) option, and stopped one supplement that her doctor felt would be safer not to take. Judith told her KnovaSolutions nurse, “The oddest thing that I discovered from my desprescribing process is that one of the medications I stopped was prescribed to treat the side effects caused by one of the other drugs I stopped. I’m so glad you and my doctor helped me!”
“The oddest thing that I discovered from my deprescribing process is that one of the medications I stopped was prescribed to treat the side effects caused by one of the other drugs I stopped.”
*Name changed for privacy
A Careful Process
The process of deprescribing should always be closely monitored by a provider who knows your medical history and conditions well. Deciding what to change is complicated, and depends upon your current health status, symptoms and personal preferences. Here are some things to consider:
- OTC medications, nutritional supplements, vitamins and herbal remedies can sometimes interact with prescription medications and/or cause side effects that are mistaken as new symptoms. Therefore, it is important to give your provider a complete list of your medicines and supplements. Also, it is important to be honest if you do not take prescribed medications as instructed (for any reason, such as they are too expensive, you never started them to begin with, you don’t like how it makes you feel, etc.).
- Deciding where to start is critical. You don’t want to change too many things at once because it will be hard to pinpoint what is working and what is not. Your provider will help establish what medications should remain stable and which may be unnecessary. S/he’ll discuss what may need to be slowly tapered before stopping or reducing, replaced with a safer drug, or whether one drug can treat multiple conditions, etc.
- Do you feel confident that both you and your provider will carefully monitor the transition period? While the goal is to reduce or stop medications that are no longer helping or are causing harm, making changes can disrupt a delicate balance. Keeping in close contact with your provider during this time can help avoid larger problems. Ask about how to handle any potential side effects, symptoms or questions.
- Your KnovaSolutions clinician can help you better understand your medications and perform a medication review. The review can identify potential adverse drug interactions, duplicate therapies (when two or more medications are used to treat the same condition), and/or safer or cheaper options. You may also learn about alternative therapies that might reduce your reliance on medications. With the results of your review, you will be better prepared to discuss deprescribing with your provider.
Call KnovaSolutions at 800/355-0885, Monday – Friday, 8 am – 5 pm, Mountain Time.
Click here to view/download the full newsletter. We encourage you to leave a comment or question below and a KnovaSolutions nurse or pharmacist will reply.
The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider. If you have concerns about your health, please contact your healthcare provider.