Fewer Pills Less Risk: A Deprescribing Resource
A Web Resource Developed for the "Collaborative Intervention for Streamlining Medication Appropriateness and Deprescribing within Integrated Health-Care Teams" Study
Principal Investigators
Nova Scotia: Dr. Melissa Andrew and Dr. Jennifer Isenor
New Brunswick: Dr. Pamela Jarrett
- Funded by the Canadian Frailty Network (CAT2017-10)
- NHSA Research Ethics Board Romeo File: #1024257
- ClinicalTrials.gov ID: NCT03903484
Frail older adults tend to have many health problems that need medications for treatment. Unfortunately frail older adults are also at risk of harm from medications. This is challenging for prescribers as medications that are helpful at one point can introduce more harm than benefit over time. Previous research has shown the benefits of stopping medications that older adults no longer need or that impart increased risk of harm. Even with this knowledge healthcare professionals do not always stop medications as often as they should or as well as they could. Stopping medications that are no longer needed or that may increase the risk of harm is called deprescribing. We are dedicated to the best possible medication use for older adults which includes regular evaluation of chronic therapy and deprescribing when appropriate. To support this mission, we have compiled resources for patients, caregivers, and healthcare providers that guide the deprescribing process. These resources were chosen carefully by our Medication Optimization Team, which includes older adults and their families, pharmacists, doctors, nurses, researchers, and healthcare policymakers who have been working to investigate and support deprescribing in primary care.
While any medication may need to be stopped, there are several classes of medications that cause the most problems for older adults. We have chosen to focus on eight drug classes:
- Benzodiazepines: diazepam, chlordiazepoxide, oxazepam, clorazepate, lorazepam, bromazepam, alprazolam, flurazepam, nitrazepam, triazolam, temazepam
- Sedatives: chloral hydrate, zopiclone, zolpidem
- Antipsychotics: chlorpromazine, methotrimeprazine, fluphenazine, perphenazine, prochlorperazine, trifluoperazine, thioproperazine, percyazine, haloperidol, droperidol, ziprasidone, lurasidone, flupenthixol, thiothixene, zuclopenthixol, pimozide, loxapine, clozapine, olanzapine, quetiapine, asenapine, risperidone, aripiprazole
- Anticholinergics (scoring 3 on anticholinergic cognitive burden scale): Amitriptyline, amoxapine, benztropine, carbinoxamine, chlorpeniramine, clemastine, clomipramine, clozapine, darifenacin, desipramine, dicyclomine, dimenhydrinate, diphenhydramine, doxepin, flavoxate, hydroxyzine, imipramine, meclizine, nortriptyline, olanzapine, orphenadrine, oxybutynin, paroxetine, perphenazine, procyclidine, promethazine, quetiapine, scopolamine, thioridazine, tolterodine, trifluperazine, truhexyphenidyl, trimipramine
- Proton Pump Inhibitors: omeprazole, pantoprazole, lansoprazole, rabeprazole, esomeprazole
- Colchicine long term
- Antihypertensives with a history of falling, hypotension or orthostasis
- Opiates
Contact
If you have any questions about this deprescribing resource, please contact: shanna.trenaman@dal.ca.
If you have personal health concerns or symptoms you believe are related to your medications or the discontinuation of your medications, please seek attention from the appropriate healthcare team member as soon as possible.