The presentation provided an overview of deprescribing, which involves reducing or stopping medications that may be unnecessary, inappropriate, ineffective, or harmful. It discussed goals of deprescribing like improving quality of life and reducing risks. Barriers and benefits of deprescribing were presented. Common drug classes that can be deprescribed included proton pump inhibitors, benzodiazepines, and others. Guidelines and tools to aid the deprescribing process were also reviewed. A case study on deprescribing a long-term PPI prescription was presented to demonstrate how to apply deprescribing principles.

1. PRESENTATION ON DEPRESCRIBING
BY
PHARM BONIFACE E. SAMUEL
PRESENTED TO THE DEPARTMENT OF PHARMACY
FEDERAL MEDICAL CENTER, KEFFI
10th JUNE. 2022

2. GROUP MEMBERS
PRECEPTOR: Pharm Linda Ohemu
SUPERVISORS: Pharm Silifat AbdulKarim
Pharm Onah Cyprian
MEMBERS: Pharm Mene Ruth Bariwu
Pharm Nwafor-Obi V. Chidinma

3. OUTLINE
 Introduction
 Goals of deprescribing
 Deprescribing rainbow
 Benefits and Barriers of deprescribing
 Pharmacists role in deprescribing
 Categories of drugs commonly deprescribed
 Resources and tools
 Additional information
 Conclusion
 References

4. INTRODUCTION
 The term “deprescribing” was first used in 2003 by Woodward, an
Australian physician
 Deprescribing is the most common intervention to help people
struggling with polypharmacy
 Deprescibing is most commonly employed in geriatric or palliative
care patients. Although it can be appropriate in other patients too
 Deprescribing is part of good prescribing
 It is a process that involves the patient, caregivers and healthcare
professional (HCP) and should be done in partnership with HCP

5. What is Polypharmacy???
 Routine use of five or more
medications
 Rate is 55% of older outpatient
 Risks:
 Adverse drug events
 Drug /drug & drug/disease interaction
 Increased mortality
 Increased cost
 Non-adherence
 Geriatric syndromes

6. Definition of deprescribing
 Deprescribing is the planned, supervised process of dose
reduction or discontinuation of medications that are:
 Unnecessary
 Inappropriate
 Ineffective
 Harmful
 More than 90% of patients are willing to stop a medication if
their doctor says it is possible

7. GOALS OF DEPRESCRIBING
 The overall goal of deprescribing is to improve the patient’s
quality of life
 Common goals:
 Reduce risk of specific geriatric syndromes
 Improve global health outcomes
 Reduce medication burden

8. DEPRESCRIBING RAINBOW

9. Clinical
 Potential medicine-related benefit vs harm
 Expected time till benefit
 Presence of symptoms
 Patient’s prognosis
 Ethical consideration
Psychological
 Cognitive function
 Health beliefs about medication and illness
 Mental health issues

10.  Health and medication literacy
 Knowledge
Social
 Influence of family and friends
 Social support
 Burden of taking multiple medicines
 Living conditions

11. Financial
 Health insurance
 Cost of medications
 Available resources
Physical
 Difficulty administering medication
 Pill burden
 Filling repeat prescriptions
 Overall health

12. BENEFITS OF DEPRESCRIBING
 Improve adherence
 Reduce financial costs
 Improves patient’s medication knowledge and satisfaction
 Resolution of adverse drug reaction
 Better quality of life

13. BARRIERS TO DEPRESCRIBING
 Multiple prescribers
 Unclear duration of treatment
 Lack of continuous medication list review
 Fear of adverse drug withdrawal effects
 Pressure to prescribe due to disease specific guidelines
 Family insists
 Patients’ view

14. PHARMACISTS ROLE IN DEPRESCRIBING
 Develop patient-pharmacist and patient-provider relationship
 Perform direct patient care, medication management and patient
education
 Coordinate care
 Promote health and wellness of patient
 Establish drug handling procedures
 Maintain all drug records

15. MEDICATIONS COMMONLY DEPRESCRIBED
 Proton pump inhibitors (PPI) [Omeprazole]
 Benzodiazepines and benzodiazepine receptor agonists [Diazepam]
 Cholinesterase inhibitors and memantine [Physostigmine]
 Antihypertensives [Lisinopril]
 Antipsychotics [Haloperidol]
 Antihyperglycemics [Metformin]
 Antidepressants [Amitriptyline]

16. RESOURCES AND TOOLS
There are a variety of resources and tools that have been developed to
support health care professionals to deprescribe such as:
A) Generic framework
Many generic (non-drug specific) deprescribing framework have been
published. These often provide a stepped approach to deprescribing,
highlighting that it is a process rather than a one-off interaction
A 6-step deprescribing framework was developed under this tool. The
steps are:

17. 1. Ascertain all drugs the patient is taking and the reasons for
each one
2. Consider the overall risk of drug-induced harm
3. Asses each drug for its eligibility to be discontinued
4. Prioritize drugs for discontinuation
5. Implement and monitor drug discontinuation regimen
6. Document the changes

18. B) Drug-specific deprescribing guidelines
Different evidence-based guidelines with easy-to-use algorithms for
deprescribing have been developed by various institutions such as:
 American Geriatrics Society (AGS) Beers Criteria
 Screening Tool of Older Persons’ Potentially Inappropriate
Prescriptions (STOPP)
 Screening Tool to Alert doctors to the Right Treatment (START)
 Bruyere Research Institute

19. Each guideline contains:
 An algorithm
 Patient pamphlet
 Infographic
 Whiteboard video for some

20. GUIDELINE FOR DEPRESCRIBING PPI

25. KNOWLEDGE AND USE OF DEPRESCRIBING
Frequency Percentage(%)
Have you heard
about deprescribing
before?
Yes 12 41.7
No 18 58.3
Have you
deprescribed before
using a guideline?
Yes 24 78.7
No 6 21.3

26. CASE REVIEW
LD, a 65 year-old woman with a 6 year history of gastroesophageal
reflux disease (GERD). She began self-medicating with over-the-counter
antacids which was not effective. She was then placed on a daily dose
of omeprazole 20mg by her primary care physician and her symptoms
improved and so, when she remembered she continued on a daily dose
for years. Last year, she noticed more burning in her chest and throat
and her PPI frequency was increased to twice daily which relieved her
discomfort.

27. During covid-19 she asked for an urgent visit, saying she’s heard that
“these heartburn drugs can give you covid-19”. Although she
acknowledges that the medication has helped her symptoms, she
wants to stop if the drug might increase her risk for covid-19.

28. What is the best course of action ???
o No change to omeprazole dose or frequency
o Discontinue the omeprazole now
o Taper the PPI to a lower-dose, once-daily tablet
o Taper the PPI and introduce a histamine-2 receptor
antagonist (H2RA)

29. CONCLUSION
 The constant increase in polypharmacy gave rise to deprescribing
 Polypharmacy is a public health problem that adversely affects the
lives of vulnerable elders and palliative care patients
 The main goal of deprescribing is to improve the patient quality of life
 Shared decision-making is essential to successful deprescribing
 There are a large variety of resources and tools that have been
developed to aid health care professionals to deprescribe
 Most studies showed that medications could be successfully
withdrawn with little or no harm to the patient

30. REFERENCES
1. Reeve E, Gnjidic D, Long J, Hilmer S. A systemic review of the emerging definition of ‘deprescribing
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2015; 80:1254
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31. THANK YOU
FOR
LISTENING