Strategies to reduce and prevent polypharmacy in older patients
Deprescribing can be accomplished by using tested tools, good judgment, and a team approach.
PRACTICE RECOMMENDATIONS
› Use one of the available tested and recommended screening tools to identify polypharmacy. C
› Engage in collaborative medication review to reduce the incidence of polypharmacy. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
CASE
After applying Beers criteria10 and STOPP15, the pharmacist makes several recommendations:
- Use aripiprazole and quetiapine with caution.
- Consider discontinuing fluoxetine, hydrocodone–acetaminophen, lorazepam, pantoprazole, and ranitidine.
- Reduce the dosage of gabapentin.
- Clarify the indication for prazosin. Consider discontinuing if being used as an antihypertensive.
In addition, the pharmacist recommends holding metformin because lactic acidosis can develop (however rarely) when a person taking metformin experiences acute kidney injury.
CORRESPONDENCE
Tracy Mahvan, PharmD, BCGP, University of Wyoming, School of Pharmacy, 1000 East University Avenue, Laramie, WY 82071; tbaher@uwyo.edu
