Reducing Inappropriate Polypharmacy¶
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., Gnjidic, D., et al. (2015). Reducing Inappropriate Polypharmacy: The Process of Deprescribing. JAMA Internal Medicine, 175(5), 827-834.
Cited by¶
2 citations across 2 artifacts.
Each citation links to the sentence it supports in the citing article.
Primes¶
- Intervention Stack Accretion
- A primary-care patient makes the accretion concrete: starting at 55 on one antihypertensive, each subsequent year adds a medication — a statin, an SSRI, a PPI to treat reflux triggered by the antihypertensive, a benzo for SSRI-induced insomnia, an analgesic, a second antihypertensive for pressure elevated under the analgesic's renal effects — until by 75 the patient is on 11 medications,
This sourceEstablishes deprescribing as the distinct named inverse-operation for accreted polypharmacy, including prescribing cascades where one drug treats another drug's side effect.
- A primary-care patient makes the accretion concrete: starting at 55 on one antihypertensive, each subsequent year adds a medication — a statin, an SSRI, a PPI to treat reflux triggered by the antihypertensive, a benzo for SSRI-induced insomnia, an analgesic, a second antihypertensive for pressure elevated under the analgesic's renal effects — until by 75 the patient is on 11 medications,
Mechanisms¶
- Minimum Effective Dose Review
- The discipline that keeps it honest is to require an explicit efficacy floor and a pre-agreed step-back before any reduction, and to lower on evidence rather than zeal
This sourceDefines deprescribing as a deliberate, evidence-informed process that weighs benefit against harm, tapers or stops treatment, and monitors outcomes.
- The discipline that keeps it honest is to require an explicit efficacy floor and a pre-agreed step-back before any reduction, and to lower on evidence rather than zeal
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