Medication discontinuation is the ceasing of a

medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...

treatment for a patient by either the

clinician A clinician is a health care professional typically employed at a skilled nursing facility or clinic. Clinicians work directly with patients rather than in a laboratory or as a researcher. A clinician may diagnose, treat, and otherwise care for pa ...

or the patient themself. When initiated by the clinician, it is known as

deprescribing Deprescribing is the planned and supervised process of intentionally stopping a medication or reducing its dose to improve the person's health or reduce the risk of adverse side effects. Deprescribing is usually done because the drug may be causin ...

. Medication discontinuation is an important medical practice that may be motivated by a number of reasons: * Reducing

polypharmacy Polypharmacy (polypragmasia) is the simultaneous use of multiple medicines by a patient for their conditions. Most commonly it is defined as regularly taking five or more medicines but definitions vary in where they draw the line for the minimum ...

* Reducing health expenditure * Improving

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

by ceasing medications with potential

adverse effects An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complica ...

or where the

indication Indication may refer to: * A synonym for sign * Human interface, highlighting the single object pointed to as a cursor is moved, without any other user action such as clicking, is indication * Indication (medicine). A valid reason to use a certain ...

for a medical treatment may have changed * Reflect changes in

evidence Evidence for a proposition is what supports this proposition. It is usually understood as an indication that the supported proposition is true. What role evidence plays and how it is conceived varies from field to field. In epistemology, evidenc ...

that support a treatment * Reflecting changes in treatment goals, such as a move to

end-of-life care End-of-life care (EoLC) refers to health care provided in the time leading up to a person's death. End-of-life care can be provided in the hours, days, or months before a person dies and encompasses care and support for a person's mental and emotio ...

. Unlike the prescribing of medications, appropriate discontinuation has not attracted nearly as much attention or interest.

End-of-life care

Medications may be stopped in the context of

, such as medications that may affect

risk factor In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often use ...

s for future disease. Medications that may be stopped as part of discussions about end-of-life care include

antihypertensives Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Evidence suggests that r ...

, medications for

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

, and drugs for

high cholesterol Hypercholesterolemia, also called high cholesterol, is the presence of high levels of cholesterol in the blood. It is a form of hyperlipidemia (high levels of lipids in the blood), hyperlipoproteinemia (high levels of lipoproteins in the blood), ...

Life limiting conditions

For people with a life limiting condition such as a dementia, it is important to consider when to discontinue medications used to prevent future serious events. The Medication Appropriateness Tool for Comorbid Health conditions during Dementia
MATCH-D
provides guidance for clinicians and consumers on how to manage medications.

Effects

Drug discontinuation may cause

rebound effect The rebound effect, or rebound phenomenon, is the emergence or re-emergence of symptoms that were either absent or controlled while taking a medication, but appear when that same medication is discontinued, or reduced in dosage. In the case of re ...

s (return of the symptoms the drug relieved, and that, to a degree stronger than they were before treatment first began) and

withdrawal syndromes Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome, is the group of symptoms that occur upon the abrupt discontinuation or decrease in the intake of pharmaceutical or recreational drugs. In order for the symptoms of wit ...

(symptoms caused by the discontinuation by the drug itself). Drug discontinuation may be difficult to adjust to, owing to the long term use and the symbolism associated with ceasing medications, such as the decision to stop

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemotherap ...

. Recent research (Nixon & Vendelø, 2016) shows that General Practitioners (GPs) who actively consider discontinuation, are reluctant to do so, as they experience that the safest decision is to continue prescriptions, rather than discontinue them. In part this is due to the ambiguity about the appropriateness of discontinuing medication. The clinical guidelines available to GPs do not encourage discontinuation of medication, and thus, they offer GPs a weak frame for discontinuation.

Anti-hypertensive drugs

Withdrawal of anti-hypertensive drugs in older people The latest evidence does not have evidence of an effect due to discontinuing vs continuing medications used for treating elevated blood pressure or prevention of heart disease in older adults on all-case mortality and incidence of heart attack. The findings are based on low quality evidence suggesting it may be safe to stop anti-hypertensive medications. However, older adults should not stop any of their medications without talking to a healthcare professional.

References

{{Unnecessary health care Clinical pharmacology Drugs Pharmaceuticals policy

End-of-life care

Life limiting conditions

Effects

Anti-hypertensive drugs

See also

References