Deprescribing is a concept that has been around for a number of years, going back to Beer’s List, originally conceived of in 1991 by the late Mark Beers, MD, a geriatrician. The Beers Criteria catalogues medications that cause adverse drug events in older adults. Amongst its most current recommendations is this:
"Avoid antipsychotics for behavioral problems of dementia unless non-pharmacologic options have failed and patient is a threat to themselves or others."
Other recent publications on deprescribing antipsychotics come from pharmacist groups in Australia and Canada and can be found in our Quick Links section.
A resource we would like to highlight in this week's Practising Wisely Newsletter is the recent review in
Canadian Family Physician
:
Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia.
The authors of this article write that "Deprescribing is the planned and supervised process of dose reduction or stopping of medication that might be causing harm or that might no longer be providing benefit." The following recommendation was made:
“We recommend deprescribing antipsychotics for adults with behavioural and psychological symptoms of dementia treated for at least 3 months (symptoms stabilized or no response to an adequate trial) and for adults with primary insomnia treated for any duration or secondary insomnia in which underlying comorbidities are managed. A decision-support algorithm was developed to accompany the guideline.”
Please visit our Quick Links section to read the full article. The decision-support algorithm can be found in the article itself, or in our Quick Links section under the Ontario Pharmacy Evidence Network link.
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