Deprescribing

In many cases, the concurrent use of multiple medications is a reality of disease management. However, each additional medication being used changes the clinical picture of individual patients. Can we create balance between the right medications and the burden of too many medications?

Deprescribing means reducing or stopping medications that may not be beneficial or may be causing harm. The goal of deprescribing is to maintain or improve quality of life. Deprescribing involves patients, caregivers, healthcare providers and policy makers.

OPEN researchers focus on optimizing all medication use and understanding how concomitant medications alter risk-benefit profiles, social costs, patient/caregiver burden. Identifying opportunities for deprescribing, developing tapering strategies, and balancing the potential impacts of continued use with those of discontinuation are ongoing priorities for OPEN research teams.

  • OPEN has successfully developed guidelines for deprescribing drugs such as proton pump inhibitors (PPIs), benzodiazepines, and antipsychotics.
  • Many of these projects include outputs that are tailored specifically for unique patient groups/environments such as long-term care and are in practical formats for healthcare providers.

This research empowers providers to use interprofessional collaboration and simplified patient-centred care when examining a patient’s drug regimen, and has led to new partnerships with organizations such as the Canadian Deprescribing Network.

Evidence-Based Guidelines

The evidence-based guidelines and their algorithms, developed by the Bruyère Research Institute Deprescribing Guidelines Research Team and its collaborators, are products of quality research and real-world application. Evidence-based deprescribing guidelines have been developed by or in collaboration with the Bruyère Research Institute for five classes of medications.

Decisions around deprescribing can be very difficult. Few evidence-based guidelines exist to support safe deprescribing for specific classes of medication. Researchers from the Bruyère Research Institute and the Ontario Pharmacy Research Collaboration developed evidence-based guidelines for deprescribing. Each guideline is summarized in an easy-to-use algorithm and information brochure. These algorithms can help health care professionals safely stop or reduce medications for specific drug classes.

Each algorithm provides evidence for the benefits and harms of continuing or deprescribing the medications. The algorithms also take into account patient preferences and values surrounding deprescribing, together with practical advice on how to implement deprescribing.

Access the guidelines and algorithms

Proton Pump Inhibitor (PPI)

Proton pump inhibitors – or PPIs – are a class of drugs used to treat heartburn, gastroesophageal reflux disease and gastric ulcers. PPIs reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid.

Antihyperglycemic

Antihyperglycemics are a class of drugs used to treat diabetes. They work in a variety of ways to lower blood sugar.

Antipsychotic

Antipsychotics are a class of drugs sometimes used for behavioural and psychological symptoms of dementia and insomnia. They are primarily used to treat psychiatric disorders such as bipolar disorder and schizophrenia, among other disorders. Antipsychotics affect a variety of neurotransmitters in the brain. This results in a calming, relaxing effect, but can also produce sedation and affect balance.

Benzodiazepine Receptor Agonist (BZRA)

Benzodiazepine receptor agonists are a class of drugs also called hypnotics or sedatives that are commonly prescribed for insomnia, among other conditions. They appear to work by suppressing the activity of nerves. This results in a calming, relaxing effect but can also produce sedation and affect memory.

Cholinesterase Inhibitors (ChEIs) and Memantine

Cholinesterase inhibitors and memantine are drugs used to treat the symptoms of dementia.

Translation and adaptations

Please use the above algorithms freely, with credit to the authors. The algorithms are not for commercial use and are licensed under a Creative Commons Attribution-Noncommercial-ShareAlike 4.0 International License. Do not modify or translate without permission. For more information, please contact deprescribing@bruyere.org.

OPEN: Ontario Pharmacy Evidence Network

School of Pharmacy
University of Waterloo - Health Sciences Campus
10A Victoria St. S, Kitchener, ON N2G 1C5

Leslie Dan Faculty of Pharmacy
University of Toronto – St-George Campus
144 College St, Toronto, ON M5S 3M2

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