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Deprescribing: Taking Control of Your Medications
Understanding the Impact of Multiple Medications
Many people take multiple medications daily, from young adults managing anxiety to older adults handling chronic conditions. In the U.S., 13% of people take five or more prescription drugs, and this number jumps to 42% for those aged 65 and older. However, taking many medications can lead to problems, such as side effects that require more medications, creating a “prescribing cascade.”
Potential Risks of Long-Term Medication Use
Medications can cause harm if taken for years. Some drugs may stop working or interact poorly with new medications. A drug that was once well-tolerated can cause side effects over time, leading to issues like cognitive decline and falls.
As Dr. Elizabeth Bayliss from Kaiser Permanente’s Institute for Health Research explains, “Our metabolism changes as we get older. Everyone’s ability to metabolize the medications they’ve been taking for a long time may change.”
What is Deprescribing?
Deprescribing is a planned and supervised process to reduce or stop taking medications. The Lown Institute, a non-profit organization, predicts that medication overload will cause 4.6 million hospital visits this decade.
If you feel overwhelmed by your daily pill routine, a medication review might be the answer. Here’s how to start.
Steps to Review Your Medications
Ask for a Prescription Checkup
Begin with a healthcare professional you trust, like a doctor or pharmacist. Pharmacist Lisa McCarthy from the University of Toronto advises making a dedicated appointment to discuss your medications, rather than bringing it up during a short visit.
Your doctor may not have the full picture if other prescribers are involved. In such cases, a pharmacist can review all your medications and provide suggestions for your doctors.
Pharmacist Bradley Phillips from the University of Florida College of Pharmacy emphasizes, “We’re considered the medication experts.”
Identify Problematic Medications
Common side effects like swelling, incontinence, restlessness, and insomnia can sometimes be caused by medications. McCarthy encourages patients to ask their doctors if their symptoms could be related to their medications and whether the medications are still needed.
Pharmacist Barbara Farrell has seen significant improvements in patients at an outpatient geriatric center in Ottawa after reducing their medications. One woman went from taking 32 pills daily to 17, enabling her to walk with a cane and return to her hobby of knitting.
Weaning Off Medications
Some medications can be stopped abruptly, but others need to be tapered off slowly to avoid withdrawal symptoms or severe consequences. This is especially true for drugs treating depression, insomnia, and anxiety.
For example, therapist Molly Bernardi from Spokane, Washington, gradually tapered off her medications after experiencing worsening side effects. The process was challenging, especially when reducing her dosage of a benzodiazepine, a class of sedatives. Bernardi found support through groups on Facebook and used techniques like breathwork and prayer.
Managing Your Medication List
Even in well-connected healthcare systems, information about prescriptions may not always be shared among doctors. Over-the-counter drugs, vitamins, and supplements may also be overlooked.
According to McCarthy, the only person who knows everything you take is you. Keep a current list of your medications, including why they were prescribed and when you started taking them. A medication list is a “tremendously powerful” tool.
McCarthy and her colleagues have developed workshop materials to help people reduce or stop medications safely.
Deprescribing can help manage the side effects and risks of taking multiple medications. By taking charge of your medication list and working with healthcare professionals, you can ensure your medication regimen is both safe and effective.
References
- Lown Institute: Medication Overload
- Kaiser Permanente’s Institute for Health Research: Dr. Elizabeth Bayliss
- University of Toronto: Lisa McCarthy
- University of Florida College of Pharmacy: Bradley Phillips
- Ottawa Hospital Research Institute: Barbara Farrell
