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The benefits and harms of deprescribing

Emily Reeve, Sepehr Shakib, Ivanka Hendrix, Michael S Roberts and Michael D Wiese
Med J Aust 2014; 201 (7): 386-389. || doi: 10.5694/mja13.00200

Summary

  • Deprescribing is the process of trial withdrawal of inappropriate medications.
  • Currently, the strongest evidence for benefit of deprescribing is from cohort and observational studies of withdrawal of specific medication classes that have shown better patient outcomes, mainly through resolution of adverse drug reactions.
  • Additional potential benefits of deprescribing include reduced financial costs and improved adherence with other medications.
  • The harms of ceasing medication use include adverse drug withdrawal reactions, pharmacokinetic and pharmacodynamic changes and return of the medical condition. These can be minimised with proper planning (ie, tapering), monitoring after withdrawal, and reinitiation of the medication if the condition returns.
  • More evidence is needed regarding negative, non-reversible effects of ceasing use of certain classes of medication, such as acetylcholinesterase inhibitors.
  • Cessation of use has not been studied for many medication classes, and large-scale randomised controlled trials of systematic deprescribing are required before the true benefits and harms can be known.

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  • Emily Reeve1,2
  • Sepehr Shakib2
  • Ivanka Hendrix3
  • Michael S Roberts1,4
  • Michael D Wiese1

  • 1 Division of Health Sciences, University of South Australia, Adelaide, SA.
  • 2 Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA.
  • 3 Pharmacy Department, Repatriation General Hospital, Adelaide, SA.
  • 4 School of Medicine, University of Queensland, Brisbane, QLD.


Competing interests:

Emily Reeve had support from the Australian Government (PhD candidacy funded by the Australian Postgraduate Award) for the submitted work. She received an honorarium for a workshop presentation from the Australian Association of Consultant Pharmacy and payment for work conducted as part of a non-related study, funded by the Society of Hospital Pharmacists of Australia Celgene Information Technology in Hospital Pharmacy grant, in the previous 3 years.

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