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Special Communication
Less Is More
May 2015

Reducing Inappropriate PolypharmacyThe Process of Deprescribing

Author Affiliations
  • 1Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Australia
  • 2School of Medicine, University of Queensland, Brisbane, Australia
  • 3Department of Clinical Pharmacology, Royal North Shore Hospital, Sydney, Australia
  • 4Kolling Institute of Medical Research, School of Medicine, University of Sydney, Sydney, Australia
  • 5Cognitive Decline Partnership Centre, School of Medicine, University of Sydney, Sydney Australia
  • 6Western Australia Centre for Health and Aging, Perth, Australia
  • 7Ageing and Alzheimers Institute, Concord Hospital and Sydney Research, University of Sydney, Sydney, Australia
  • 8National Prescribing Service MedicineWise, School of Pharmacy, University of Queensland, Brisbane, Australia
  • 9School of Pharmaceutical Sciences,Queensland University of Technology, Brisbane, Australia
  • 10School of Pharmacy, University of Sydney, Sydney, Australia
  • 11Centre for Research in Evidence-based Practice, Bond University, Gold Coast, Australia
  • 12School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
  • 13School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
  • 14Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, Australia
  • 15PA-Southside Clinical School, University of Queensland, Brisbane, Australia
JAMA Intern Med. 2015;175(5):827-834. doi:10.1001/jamainternmed.2015.0324

Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predictor of inappropriate prescribing and risk of adverse drug events in older patients is the number of prescribed drugs. Deprescribing is the process of tapering or stopping drugs, aimed at minimizing polypharmacy and improving patient outcomes. Evidence of efficacy for deprescribing is emerging from randomized trials and observational studies. A deprescribing protocol is proposed comprising 5 steps: (1) ascertain all drugs the patient is currently taking and the reasons for each one; (2) consider overall risk of drug-induced harm in individual patients in determining the required intensity of deprescribing intervention; (3) assess each drug in regard to its current or future benefit potential compared with current or future harm or burden potential; (4) prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes; and (5) implement a discontinuation regimen and monitor patients closely for improvement in outcomes or onset of adverse effects. Whereas patient and prescriber barriers to deprescribing exist, resources and strategies are available that facilitate deliberate yet judicious deprescribing and deserve wider application.