March 16, 2017
I take six prescription medications a day (plus two vitamin supplements and a baby aspirin). So when an article in The Washington Post by a professor of family medicine at Georgetown University declared “too many patients are taking too many drugs for too long in too-high doses”, I read on.
In it, Dr. Ranit Mishori notes that “few drugs are meant to be used forever, and all have potential to cause harm.” So, she writes, she made a New Year’s resolution this year to not only write fewer prescriptions but to also try to get more of her patients off their drugs altogether.
Not an easy thing to do, though. Doctors are taught how to prescribe drugs, she says, but not how and when to deprescribe them. For some medications, cutting back or stopping must be done gradually and carefully with a lot of thought and planning.
The article goes on to describe common classes of medications that are good candidates for deprescribing, like antidepressants, anti-cholesterol statins, and proton pump inhibitors, for example.
“Knowing which classes of drugs require special attention is important,” she says, “but it is not enough. How to do it effectively, efficiently and with the lowest chances of harm is still anybody’s guess,” adding that more research is needed to discover what she calls the best discontinuation protocols.
In the meantime, she advises patients to be proactive and ask their doctors these questions:
What is each medication for?
Are there any non-drug alternatives?
How long do I need to be on them?
What are the benefits of continuing to take each one?
What are the potential downsides?
What about possible drug interactions?
Can I lower my doses of any?
So many questions to remember to ask and take notes. We are going to need an organizer for that proactive action. Which are likely to become less beneficial considering my age, other medical conditions, and life expectancy?
Can I get off any completely? Sounds reasonable to me.