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Take detailed medication history including indication for each drug.
Consider potential for drug induced harm ie age of patient, comorbidities, number of medications, types of medications.
Consider each individual medication and the potential to provide ongoing benefit.
Prioritise medications for deprescribing (usually one at a time), give explanations to patient. Agree follow-up arrangements.
Carry out follow-up assessment to assess effects of deprescribing. Consider further deprescribing.
Limited time.1
Lack of clarity over whose role it is to deprescribe. 8
Concern regarding stopping medications initiated by specialists. 1
Uncertainty regarding the ongoing benefits of medications. 1
Concern over drug withdrawal effects. 2
Uncertainty regarding the timing of deprescribing discussions when goals of care are unclear. 1
Concern from healthcare professionals that patients may feel they are ‘giving up hope’. 9
Reluctance from patients to change medications. 2
Class of medication Medication Situations of limited benefit Aspirin Aspirin Primary prevention Lipid lowering medications Statins
Fibrates
EzetimibeAll indications Blood pressure lowering medications ACE inhibitors
Sartans
Beta blockers
Calcium channel blockers
Thiazide
DiureticsMild to moderate hypertension
Secondary prevention of cardiovascular events
Management of stable coronary artery diseaseAnti-ulcer medications Proton pump inhibitors
H2 antagonistsAll indications unless recent history of gastrointestinal bleeding, peptic ulcer, gastritis, GORD, or the concomitant use of NSAIDs and steroids Oral hypoglycaemics Metformin
Sulfonylureas
Thiazolidinediones
DPP-4 inhibitors
GLP-1 analogues
AcarboseMild hyperglycaemia (prevention of diabetic complications) Osteoporosis medications Bisphosphonates
Raloxifene
Strontium
DenosumabAll indications except hypercalcaemia Vitamins n/a All except treatment of low serum concentrations Minerals n/a All except treatment of low serum concentrations Complementary therapies n/a All indications Adapted with permission from Lindsay J, Dooley M, Martin J et al. The development and evaluation of an oncological palliative care deprescribing guideline: the ‘OncPal deprescribing guideline’. Support Care Cancer 2015;23:71–8.
ACE = angiotensin-converting enzyme; DPP-4 = dipeptidyl peptidase-4; GLP-1 = glucagon-like peptide-1; GORD = gastro-oesophageal reflux disease; NSAIDs = nonsteroidal anti-inflammatory drugs; n/a = not applicable.
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