John Murphy. MDLinx. February 10, 2020

Doctors learn enough about prescribing medications but enough as much about deprescribing them. Accordingly, numerous patients end up on various medications, several of which they may no more need.

Nearly 50% of older adults take five or more medications, and at least one in five of these prescriptions is potentially inadequate. Polypharmacy is a scientific challenge because the health care system is directed toward initiating medications, not lowering or discontinuing them, and guidelines generally consider recommendations for starting medications, but not stopping them. Essentially there is an art and science to prescribing medications, similarly, there’s a complementary art and science to deprescribing them. In this regard, there are five medications that doctors may recommend deprescribing – with respect to individualized therapy, of course.

Proton pump inhibitors

Proton pump inhibitors (PPIs) are extensively prescribed, unusually deprescribed, and frequently purchased over the counter. They’re regularly utilized without medical indication and for a very long time than required. Only 2 weeks it has general indication and not for long term. Though PPIs have traditionally been considered safe, they’ve since been associated with serious adverse events such as cardiovascular disease (CVD), pneumonia, osteoporotic fractures, Clostridioides difficile infections, acute kidney injury, chronic kidney disease, dementia, upper gastrointestinal cancer, and death.

“Given the millions of people who take PPIs frequently, this alters into thousands of excess mortality rate every year,” reported by nephrologist Ziyad Al-Aly, MD, Clinical Epidemiology Center, Department of Veterans Affairs St. Louis Health Care System, St Louis, MO, whose research team associated PPIs to higher mortality. He also reported that there is need to stop taking PPIs when not medically necessary and for those who have a medical need, PPI use must be restricted to the lowest effective dose and shortest duration possible.”

Statins

Statins are among the most regularly prescribed drugs, with greater than 35 million Americans receiving them. It was concluded that there was restricted evidence on the potency of using statins for the primary prevention of CVD. In a corresponding study, the researchers identified that the number needed to treat to prevent one major vascular event was 400 for low-risk patients compared with ≤ 25 for very high-risk patients. The author recommended that while deciding whether to prescribe statins, clinicians should consider individual baseline risk, absolute risk reduction, and whether the risk reduction justifies the potential harms of taking a daily medicine for life.

Antibiotics

Approximately all doctors would approve that antibiotic overprescribing is a problem, and still the problem continues. According to the Centers for Disease Control and Prevention (CDC), in US outpatient settings, of the estimated 154 million antibiotic prescriptions written each year, at least 30% are unnecessary. According to the Food and Drug Administration (FDA), more than 70% of the bacteria responsible for the 2 million infections obtained in US hospitals each year are resistant to at least one commonly used antibiotic. Beside antibiotic resistance, the risks of antibiotic excessive use or overprescribing involve rise in disease severity, disease length, health complications, adverse effects, mortality risk, healthcare costs, re-hospitalization, and medical treatment for health problems that might have otherwise settled by themselves.

Antimuscarinic drugs for overactive bladder

Antimuscarinic drugs for overactive bladder are not especially potent. They also have a high incidence of adverse effects. As outcomes of these two factors, patients usually stopped taking these drugs (or want to discontinue them). “A major rationale for patient’s not resuming treatment was that they experienced no difference in symptoms on or off treatment,” reported by pharmacist Seema Gadhia in The Pharmaceutical Journal. Antimuscarinics also have a significant risk of adverse side effects that restrict their tolerability. The most common adverse effects include dry mouth, constipation, blurred vision, somnolence, and dizziness. Long-term use of antimuscarinics has also been linked with an high risk of cognitive impairment and death in older adults.

Benzodiazepines

Benzodiazepines and related “Z” drugs—such as zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata)—are sedative-hypnotics frequently prescribed to treat anxiety, mood disorders, depression, and insomnia, as well as seizures. Basically, they’re very commonly prescribed—over 5% of US adults are on benzodiazepines, according to one estimate. Misuse of benzodiazepines is also common, with 5.3 million Americans taking benzodiazepines in a manner not prescribed by their physicians. Misuse such as taking the drugs without a prescription, taking higher doses than prescribed, and taking them more regularly or for longer than prescribed. Worse still, benzodiazepine misuse is strongly associated with misuse and abuse of prescription opioids, as one-third of opioid-related overdoses and one-fifth of opioid-related mortality rate also involve benzodiazepines. Keith Humphreys, PhD, professor and section director for Mental Health Policy, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, in a Washington Post article reported that the risks of benzodiazepines have attracted far less attention than those of opioids and multiple health-care organizations, physicians and patients remain ignorant of the country’s benzodiazepine problem.