Deprescribing is the cure for ‘disease’ of polypharmacy

Prescription drug use is rising in the United States, outpacing population growth.  According to a nationwide survey published in Consumer Report in August 2017, the number of prescriptions increased 85% over 20 years, while the population grew by 21%.   Some of the increase stems from polypharmacy as 77 million baby boomers reach their 70s.

A study published in the April 2016 JAMA Internal Medicine found that among adults with a mean age of roughly 71 years, 35.8% take at least five prescription medications, and 67.1% take five or more medications or supplements of any kind, including OTC medications.

Polypharmacy of that magnitude carries so great a risk for negative outcomes in older adults that is should be seen as a disease, said Andrew Whitmann, PharmD, clinical pharmacist in oncology and palliative care at the University of Virginia System in Charlottesville, VA.

“If you break down polypharmacy as you would a typical disease, it has the same elements.  It comes with risk factors like chronic disease states, polymorbidity, transitions of care, and seeing a number of different prescribers,” Whitman said.  “It also has symptoms or consequences, like nonadherence of other essential medications, cognitive impairment, falls, pill burden, and personal and health care financial toxicity.   Finally, it can have exacerbating factors, including prescribing cascades, lack of communication among providers, and lack of education for patients.”

The cure, then, is deprescribing, Whitman said.

“Deprescribing should also be part of the good prescribing continuum.  I tell all of my patients that most of their medications have a ‘do not use beyond’ date when the medication may no longer be needed or have a different impact on their body as they age,” Whitman said.

Tools abound for assessing polypharmacy, with the Beers Criteria setting the standard.  But in a pilot study Witman and his colleagues published in the December 2018 Supportive Care in Cancer suggests that the Beers Criteria alone may not be enough.   In the study, the researchers collected data from 26 patients with cancer who were at least 65 years of age.   After assessment with all screening tools, 73% of potentially inappropriate medications were deprescribed (roughly three medications per patient), and approximately two-thirds of patients said they had fewer symptoms after the deprescribiing.   Whitman and his team estimated that deprescribing potentially avoided $4,282.27 in health care costs per patient.

For the full article, visit for the December 2018 issue of Pharmacy Today.