Editorials

Discontinuing drug treatments

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7013 (Published 21 November 2014) Cite this as: BMJ 2014;349:g7013
  1. Danijela Gnjidic, lecturer and NHMRC early career fellow12,
  2. David G Le Couteur, professor of geriatric medicine23,
  3. Sarah N Hilmer, head of department of clinical pharmacology24
  1. 1Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
  2. 2Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  3. 3Ageing and Alzheimers Institute and Concord Hospital, Sydney, NSW, Australia
  4. 4Royal North Shore Hospital and Kolling Institute of Medical Research, Sydney, NSW, Australia
  1. danijela.gnjidic{at}sydney.edu.au

We need better evidence to guide deprescribing

Deprescribing is the process of withdrawing drugs in an attempt to improve patient outcomes. Emerging evidence from studies of patients with multimorbidity and older people, who are a large and growing proportion of the population, shows that deprescribing may be linked to improvements in survival and quality of life.1 2 While it is sometimes asserted that patients are unwilling to have their drugs withdrawn, in a recent survey over 90% of patients reported that they would be willing to stop taking one or more of their medicines.3 Deprescribing should be considered during every regular review of a patient.

The principles of prescribing and deprescribing are highly comparable,4 although with obvious differences. Prescribing new drugs involves diagnosing a problem and establishing an indication; deprescribing involves establishing which drug may be causing a problem (an adverse drug event) or which drug does not have a current indication. Prescribing involves applying specific disease based guidelines to a patient; deprescribing involves optimising all treatments to achieve individual care goals. While prescribing for people with multimorbidity is commonly driven by guidelines that are based on single diseases, the …

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