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Medical News & Perspectives
November 29, 2023

Deciding When It’s Better to Deprescribe Medicines Than to Continue Them

JAMA. 2023;330(24):2328-2330. doi:10.1001/jama.2023.22245
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Seasons change, fashions change, US presidents change, but for many patients, prescriptions never do—except to become more numerous.

Among US adults aged 40 to 79 years, about 22% reported using 5 or more prescription drugs in the previous 30 days, according to data from the National Center for Health Statistics (NCHS), part of the US Centers for Disease Control and Prevention.

Within that group, people aged 60 to 79 years were more than twice as likely to have used at least 5 prescription drugs in the previous month as those aged 40 to 59 years, according to the NCHS. On average, 750 older adults in the US are hospitalized each day because of adverse drug events, notes the Lown Institute, a think tank in Needham, Massachusetts.

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2 Comments for this article
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Deprescribing Medications
Howard Birenbaum, MD | Neonatalogy Consultants
This is an issue in many neonatal intensive care units as well. Many drugs are prescribed but there is often hesitancy in weaning/discontinuing them. Diuretics come to mind but there are others, including supplemental oxygen. There is often the fear of decompensation and upsetting families. But in the case of diuretics, electrolyte abnormalities are not uncommon and require frequent electrolyte determinations. Many neonates are then supplemented with sodium or potassium.
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There are Downsides To Deprescribing, Too
Jennie Orr, MD | Retired
While I agree that many meds stay in patient's routines when the indications are long gone and the meds should be removed, it is not always a benign procedure.

I know of a patient in hospice who would have died shortly anyway, but her actual death was precipitated by stopping her diuretic for heart failure that was thought to have been contributing to her mental decline. It was slowly weaned, with no apparent effect on her condition until the last 1/2 tab of the smallest size was stopped and her heart failure promptly and distinctly worsened. Her nursing
home had disposed of her unused pills and, due to a nationwide shortage, no more could be obtained and the state law would not allow the nursing home to use some slightly out-of-date ones we had at home and her lungs filled up with fluid and caused her demise within just a few days.

While not being able to restart a stopped medication is not common, having a seizure after stopping an anticonvulsant is not, even if it only happens to maybe a third of patients. Having a seizure results in a 3 month loss of driving privileges in our state, even if the stop of medication was at a prescriber's recommendation. I don't know too many people with driver's licenses who are totally seizure free on medication who would be willing to chance it.

I'm totally for deprescribing benzodiazepines and anticholenergics that really don't do much for incontinence, but think twice about what might happen to the patient if it turns out they really do still need that medication you are planning to deprescribe after all.
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