Medication changes after review
Medications most commonly deprescribed successfully and consistently in
the reviewed studies included multivitamins, proton pump inhibitors,
antihypertensives, and analgesics. Statins were also able to be easily
deprescribed in patients with limited life
expectancy.25,34 Antidementia drugs and antipsychotics
were reduced after CGA29; however, another study noted
that antipsychotics were often psychiatrist managed and this was a
barrier to deprescribing attempts.25 Another perceived
barrier to deprescribing cited by doctors was a lack of information
regarding the indication of medications. This was highlighted as a
significant reason why proton pump inhibitors are
continued.35 (A particular concern given the possible
long-term effects of proton-pump inhibitors, including an increased risk
of gastric cancers).70 It was noted that the
medications identified as inappropriate in these outpatient clinics are
similar to those highlighted in other clinical
settings.13,71
In the haemodialysis outpatient unit, targeted deprescribing of quinine,
diuretics, statins, α1-blockers, and proton pump inhibitors was
effective using a medication algorithm.35 In the
memory clinic, medications affecting cognition were a focus and they
were able to deprescribe benzodiazepines and tricyclic
antidepressants.37 It was suggested that
deprescription may be most successful when targeting select classes of
drugs and following patient-specific drug
recommendations.15