Bottom Line: Doctors know how to prescribe—but how many know how to deprescribe?
It happens for the best of reasons. Your cardiologist, say, prescribes one medication, then you see your endocrinologist and get another, and your rheumatologist gives you another—and the doctors don’t talk to one another. Each is trying to help you—but collectively, they could be hurting you…possibly badly.
Polypharmacy—taking a combination of medications that does more harm than good—is a national epidemic, and it’s getting worse. The truth is, our medical system is a lot better at prescribing medications than at stopping ones that are no longer needed—deprescribing. Yet doing so, carefully and under medical supervision, reduces the adverse side effects and often improves health. Would it help you to deprescribe?
Polypharmacy can happen before you know it. Case in point: Many medications, regardless of the conditions they’re prescribed for, can have depression as a side effect. They include certain blood pressure drugs…heart drugs…drugs for heartburn (proton pump inhibitors)…even painkillers. The more of these drugs you take, the higher your statistical risk of developing depression.
Polypharmacy also is associated with a host of other adverse effects including an increased risk for falls and cognitive impairment that can lead to emergency room visits and hospitalization. The problem often gets worse as you get older—you’re not only likely to need more medications, but your body’s ability to process those medications declines. A drug or dosage that was appropriate when initially prescribed might no longer be safe or appropriate. However, polypharmacy can happen at any age.
You now understand polypharmacy. For an idea of how deprescribing can work, consider this case study…
The woman sat slumped over in her chair—and then slid out onto the floor when she tried to stand. She had been diagnosed with dementia and was on the waiting list for a long-term-care facility, where she seemed likely to live out her remaining days. Instead, 10 weeks later, she was walking and living an active life. Her long-term-care stay had been canceled—her doctors realized that she did not even have dementia!
What changed? A medical team reviewed this woman’s case and discovered that she was taking 32 prescription medications each day—and together, the medications that had been prescribed to help this woman instead were ruining her life. The review team gradually eliminated 15 of those drugs and reduced the dosages of several others.
For most, polypharmacy’s effects are subtler. And to determine whether it’s happening to you, you probably will need to press your doctor or doctors. Most physicians are far more likely to write prescriptions than to review and eliminate them. That’s slowly changing, but for now it’s up to you to take the lead. Here’s how…
Make a medications list. It’s a good idea to put all your prescription drugs, over-the-counter medications, vitamins and other supplements in a bag and bring them to your doctor and ask for a review. But also bring a list of each of these, including dosages, to help your doctor review them accurately and quickly. Group drugs together on the list by their purpose—heart drugs, pain drugs, etc.
Call your doctor’s attention to medications that are likely to be problematic. Certain kinds of prescription drugs, if used long term, are particularly likely to cause problems…
Ask your doctor—or doctors—to review all your medications. You might start a conversation this way—“I read an article about the dangers of polypharmacy, and I want to take a serious look at all of the medications I am taking…” For any particular medication, you might ask,“Is this prescription and dosage a problem to take for as long as I’ve been on it? Is it appropriate for my age? Could I be on a lower dose?” If you see several specialists, have this conversation with each one.
If you are prescribed medications after a hospital stay, follow up with your own doctor. According to a study of elderly patients discharged from 11 Veterans Affairs medical centers, 44% were prescribed one or more unnecessary drugs.
And even if the medications are appropriate for you at discharge, ask your doctor—or the hospital pharmacist—which ones you can stop taking a few weeks or a month later.
To reduce your odds of being given unnecessary prescriptions in the first place…
If you develop a new health problem, raise the possibility that drugs are causing it. Ask, “Could this be a side effect of any of the drugs I’m currently taking or the combination of drugs?” It might not be, but you’ll ensure that your doctor considers that possibility.
Ask the following questions about any new medication—how long should you take it…how will you know whether it’s working…and what side effects should you watch for. Jot down your questions before you see your doctor.
Explore lifestyle changes that can reduce the need for certain prescriptions. Example: Consider relaxation techniques before resorting to sleeping pills.
Talk to your pharmacist. With any new prescription, raise the question of polypharmacy with your pharmacist. If he/she has a concern that your doctor did not bring up, ask him to call your doctor’s office to resolve the situation. Helpful: Use the same pharmacy for all your prescriptions. That increases the odds that the pharmacist will spot potentially problematic drug interactions even before you ask about them.
Be aware of the risks of stopping certain medications too quickly. Discontinuing certain prescription drugs can cause side effects—and some can be dangerous. This is especially true for certain classes of medications including antidepressants, blood pressure drugs called beta-blockers and sleeping pills. But there are others, too. So don’t reduce or stop any drug without guidance from your doctor…and if a doctor does recommend ending a drug, ask whether it needs to be tapered and, if so, ask for detailed instructions on how to do that properly.
