Ask Your Pharmacist

March 13, 2020
Q:

What can you tell me about deprescribing, especially for people like me who are getting up there in years?

A:

Thanks for your question! There certainly is lots of buzz about deprescribing. I was surprised myself when I researched this topic.

According to the Canadian Institute for Health Information, in 2016 one in four Canadians over the age of 65 years was prescribed 10 or more classes of medications.

What is exactly does deprescribing mean?

Deprescribing means working with your doctor or nurse practitioner, and pharmacist, to reduce the dosage of, or discontinue medication(s), that are no longer needed or may be causing harm. About seven in 10 Canadian seniors are willing to stop a medication if the doctor says it is possible.

How does aging affect our response to medications?

As we age, our body changes and these changes can make us more sensitive to medications. For example, the brain becomes more sensitive to drug effects as we grow older. Medications may stay longer in our body because we have less muscle and more body fat. Our liver and kidneys do not process medications as efficiently as when we were younger. Our body contains less water and medications can become more concentrated. 

Why is deprescribing important?

According to the Institute for Safe Medication Practices Canada, deprescribing provides an opportunity to improve your quality of life by reducing the use of potentially harmful or ineffective medications. All medication has benefits but also side effects or risks. Over time and as we grow older, some medications that were started for a good reason are no longer necessary and may even cause harm because of side effects or drug interactions. These unintended harmful effects of medications may include falls, memory problems, hospital admissions or death.

Is there more risk associated with some medications than with others as we grow older?

Yes. Some medications are riskier for people over the age of sixty-five. Risky medications are associated with higher incidence of medication-related harms such as memory problems, falls and fractures. 

Examples of classes of medications to be considered for deprescribing in the seniors include: non-steroidal anti-inflammatory drugs (i.e. ibuprofen or Advil®, naproxen or Aleve®), antipsychotics when used as a sleeping pill or for dementia behavioral and psychological symptoms (i.e.,  quetiapine or Seroquel®, risperidone or Risperdal®), long-acting type-2 diabetes medications (i.e. glyburide or Diabeta®), first-generation antihistamines (i.e. diphenhydramine or Benadryl®), opioid medication for chronic pain (e.g. oxycodone and combinations such as  OxyNeo®, Percocet®), benzodiazepines (i.e. alprazolam or Xanax®), and proton-pump inhibitors (e.g. pantoprazole or Pantoloc®)

What are some questions you can ask your doctor or nurse practitioner about deprescribing?

When you are prescribed a new medication, talk to your doctor or nurse practitioner about your options. For example, alternatives to riskier medications may be available which may be equally or more effective than the medication you are currently taking. Alternatives can include other prescription medications or over-the-counter medications. Certain lifestyle changes (diet, sleep, exercise) can help treat some health problems. For example, alternatives to sleeping pills may include improved sleep habits. Better control of blood sugars in people with diabetes mellitus may be possible with regular physical activity, healthy diet and a healthy body weight. Alternatives to proton pump inhibitors for acid reflux may include histamine receptor blockers (i.e. Pepcid), dietary changes, and a healthy body weight.

What are some questions you can ask your pharmacist about deprescribing?

It is very important to talk to your pharmacist each time you get a new prescription filled.  Some questions to help guide your conversation might include: Why am I taking this medication? What are the potential benefits and harms of this medication? Can it affect my memory or cause me to fall? Can I stop or reduce this medication? Who do I follow-up with and when? If you don't know the answers to these questions as you read this article, consider scheduling a medication review with your pharmacist at your next visit.

Talk to your doctor, nurse practitioner, or pharmacist before attempting any change to your medications. For more information on deprescribing, check out the Canadian Deprescribing Network: https://www.deprescribingnetwork.ca/deprescribing

Dr Kevin Duplisea (PharmD BSc. Pharm, BSc. ACPR) is a pharmacist at Sharp’s Corner Drugstore in Sussex, New Brunswick. His opinions expressed in this newspaper are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.