Medication discontinuation is the ceasing of a medication 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. Medication discontinuation is an important medical practice that may be motivated by a number of reasons: * Reducing polypharmacy * Reducing health expenditure * Improving quality of life by ceasing medications with potential adverse effects 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 factors 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, and drugs for high cholesterol.

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 effects (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. 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