Deprescription: The prescription metabolism

Abstract

Deprescribing is a structured approach to drug discontinuation. An alternative suggested term is “prescription metabolism.” The major aim of deprescription is to purge the drug(s) considered unwanted in a given patient, especially in the elderly patients with multiple comorbidities or in those suffering from chronic disease. Like drug metabolism, prescription metabolism is a way of eliminating unwanted, troublesome, or cost-ineffective medications. The removal of such drugs has been found to decrease the incidence of adverse drug reactions and improves the rate of medication adherence, thereby reducing the economic burden on the patient as well as on the health care providers. Certain categories of drugs are to be tapered rather than abruptly stopped. Despite the availability of many tools to minimize drug therapy-related problems, there is little guidance for the process of deprescribing in general clinical practice. Various methods to reduce the risks of polypharmacy include patient education, physician education, and regulatory intervention. The suggested S and S approach (seek and screen, save and severe, sensitize and supervise) may be tried for deprescribing in general practice. More research on deprescribing is the need of the hour in almost all branches of clinical medicine which may pave the way for the betterment of health care.

Assessing the overall medication use by elderly people in a Brazilian hospital using the start/stopp criteria version 2

“…The most commonly used health intervention for the elderly population is the administration of medicines (Menesier, Menicier-Ossia, 2017). However, polypharmacy can lead to the irrational use of medicines (Sivagnanam, 2016). Pharmacological treatments should be used with special caution among the elderly people, given that their organism presents physiological changes, such as decreased muscle mass and body water, as well as changes in the absorption, distribution, metabolism, and excretion of the medicines.…”

Polypharmacy in Zoological Medicine

“…The next step is to adapt the process of “deprescribing”, i.e., decreasing the number of concurrently administered pharmaceuticals [ 23 ]. The goal is to actively remove unnecessary or potentially unwanted treatments administered to a given patient.…”

“…The goal is to actively remove unnecessary or potentially unwanted treatments administered to a given patient. Removing such drugs has been proven to decrease the incidence of adverse drug reactions, and improve the rate of medication compliance, thereby reducing the economic burden on both the patient and the health care provider [ 23 ].…”

Reducing harms: Focus on drug-drug interactions and adverse drug events

“…Nonetheless, the philosophy of "deprescribing" is of some merit and is worth considering 3 ; deprescribing is the process of withdrawal of an inappropriate medication, supervised by a healthcare professional with the goal of managing polypharmacy and improving outcomes. This is especially attractive for elderly patients with multiple comorbidities or those suffering from chronic disease, 4 and where multiple medications taken more than once daily can make adherence challenging even for the most cognitively intact and motivated patient. 5,6 At a minimum, prescribers need to know exactly what their patients are taking.…”