Laura Hanson, MD, deprescribing

Have you ever started taking a medication and discovered that it produced an unpleasant side effect? That’s not uncommon. Sometimes the doctor responds by prescribing an additional drug to manage a side effect from the first one. Occasionally a person will get caught in a cascade that results in several drugs to treat side effects caused by other medications. Changing the original prescription or deprescribing some of the medications might be the best solution.

When Does Deprescribing Make Sense?

As we grow older, we often accumulate health conditions along with our birthdays. The consequence can be a handful of pills to treat those conditions. Are there times when it makes sense to cut back on some of the treatments?

Older people are especially likely to be taking a large number of medicines. As life expectancy grows shorter, preventive medications may make less sense. When is it reasonable to de-prescribe?

Join the Conversation:

If you have questions about de-prescribing, you can ask our experts: Call 888-472-3366 between 7 and 8 am EDT on January 28, 2017, or email radio@peoplespharmacy.com

Patients and prescribers can find out about deprescribing practices at Deprescribing.org

This Week’s Guests:

Mitchell T. Heflin, MD, MHS, is Associate Professor of Medicine and Senior Fellow in the Center for the Study of Aging and Human Development and Duke University School of Medicine.

Laura C. Hanson, MD, MPH, is Professor in the Division of Geriatric Medicine in the Center for Aging and Health and the UNC Palliative Care Program at the University of North Carolina School of Medicine. The photo is of Dr. Hanson.

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The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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Air Date:January 28, 2017

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  1. Leroy
    Alaska bush
    Reply

    This is a great topic, and overprescribing is pandemic, especially in pscychiatry. I was on benzos for 14 years, and after a 2.5 yr taper was weaned off them. Up to 5 mg a day of Clonapin that took 5 attempts to be successful. I developed severe withdrawal syndrome. My advice is to take no more than 2 attempts to avoid w/d challenges. Most importantly, over a 10 yr professional relationship , the prescriber gave me over 12 other prescriptions to try. I initially told him I was taking them all, and after several yrs, let him know that I took none. During the compliant stage, he thought I was doing well. The truth of the matter is, many meds, especially benzos, cause symptomology that “requires” prescribing more meds leading to overprescribing! The protocol of psychiatry is pharmacologically based and this cultural phenomena needs to change.

    I recovered after seeking out and finding wholistic psychiatrists who were willing to help those harmed by toxic psychiatry. You, as a patient, need to be informed well beyond the very selective disclosure given to you by prescribers. Most importantly, a path towards possible cessation needs to be established before ingesting 1 pill, especially where psychotropic compounds are concerned. This needs to be included in any patient Bill of Rights, as important as any possible known side effects. Really, benzos will continue to be mis-prescribed. Until a drug w/ an unsafe efficacy rate, like Clonapin, is banned, people will be harmed w/o the harm redcution strategies discussed above.

    It will also take a major class action lawsuit to challenge the “benzo” culture in psychiatry. That will be forthcoming, especially in light of recent government litigation against major pharmaceutical companies that were opioid providers. Please, educate your- self before ingesting anything, and support the lifelong work of The People’s Pharmacy and there immense imformation and knowledge base.

  2. James Magee
    Illinois
    Reply

    1/31/2017: You cant download the MP3. The link takes you to buying the CD for $9.99.

    PEOPLE’S PHARMACY RESPONSE:
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    Thanks for your interest,
    -The People’s Pharmacy Customer Service

  3. Marie
    Sweden
    Reply

    A COMMON PROBLEM IN MANY COUNTRIES

    The problem of overmedication is common in many countries. It has been going on for years and years. I don´t think the change will come from our authorities or the medical staff. I think it will have to come from the people. I live in Sweden.
    I have read many articles in papers and on the Internet and many, many books and tried to make up my own mind in order to help overmedicated relatives. There are so many interesting, critical books out there. Here are some:

    Malignant Medical Myths (2006) – Joel M. Kauffman
    How Patients Should Think – Ray Moynihan and Melissa Sweet
    Death by Prescription – Terence H. Young
    Are your prescriptions killing you – Armon B. Neel and Bill Hogan
    Selling Sickness – Alan Cassels and Ray Moynihan
    Seeking Sickness – Alan Cassels (about screening)
    Rethinking Ageing – Nortin M. Hadler
    Anatomy of an Epidemic – Robert Whitaker
    Mad in America – Robert Whitaker
    The Pills That Steal Lives – Katinka Bradford-Newman (about antipressants etc.)
    Top Screw Ups Doctors Make and How To Avoid Them – Joe and Teresa Graedon
    The Fluoride Deception – Bryson
    White Coat – Black Hat – Carl Elliott
    Doctoring Data – Malcolm Kendrick
    Ignore the akward – Uffe Ravnskov
    Statins Toxic Side Effects – David Evans
    The Statin Damage Crisis – Duane Graveline
    Our Daily Meds – Melody Petersen
    Overdiagnosed – Gilbert H Welch, Lisa M. Schwartz and Steven Woloshin
    The Antidepressant Fact book and many other books about psychotropic drugs by Peter R. Breggin
    Last but not least I would like to recommend Alan Cassels monthly articles on the Canadian site – http://www.commonground.ca

    Maybe someone else can come with some recommendations?

  4. Paul
    13760
    Reply

    Hi, I’m off all my HBP meds and I reduced my BP from 239/100 to about 122 to 135/ 59 to 73 mmHg ie 130/65. How do I know what did was right ? I did an IVP and it said that my kidneys were ok. 2nd I did a pee in the bottle test Range/24hrs = 800-2000mls/24 hrs. I came in at 2163mls/24hrs! I 1st assumed it was milk plugging up my kidneys. I stopped and started drinking water with green tea. My BP went from 239/100 to 170/70 mmHg , but no farther. So, I guessed it was some kind of tumor from football.

    My epinephrine was at 2 pg/ml and 10-230pg/ml was the range. My norepinephrine was at 636pg/ml and 230 to 520 pg/ml was the range. 700pg/ml is pheochromocytoma which I hadn’t got to yet. So, I looked at a computer list of about 7 foods that increased epinephrine levels and chose two. They were vanilla and chocolate dark. I used a powder coffee creamer for the vanilla and a brand of chocolate between milk and dark.

    About 6 months later, my BP dropped to normal, which is at the beginning of this scenario. I haven’t rechecked my catecholamine for epi and norepi yet but all I know is I’m off all my meds with a normal BP at 70 yrs of age. Yes, 122/59 is too low. :=))). pcg o&o

  5. Linda
    Pinehurst, NC
    Reply

    I was interested in getting the guide book on medications that are not recommended for older people but I can’t find a place on the site to request it. Can you help?

  6. Peggy
    Florida
    Reply

    Benzodiazipine de-prescribing: I took Klonopin for 20 years for insomnia, as much as 4 mg per night. I started to taper off slowly and this took over two years. Despite this effort, I went into a severe withdrawal with physical symptoms: burning, stinging, heat, spasms, nerve pain, paresthesias, intense spaciness, dizziness, memory problems, nausea/loose bowels, constipation, weight loss, and others.

    Much of this has greatly decreased after 19 months post last dose and I have gained 15 pounds. But symptoms still keep me up at night, mainly paresthesia, and bother me during the day. Slowly I am recovering from this terrible ordeal. I take no prescriptions. I have a very supportive doctor. I am now 70.

    Also- I just had a genetic test at a university teaching hospital and I am positive for NAT2 *6a/*6a. The geneticist said this is why the drug withdrawal was so bad.

  7. Susan
    Houston
    Reply

    My late mother-in-law was on numerous medications and the number was growing as she developed new ailments. Unbeknownst to her children, she had gone through her entire savings and had began selling off family heirlooms to pay for all of her medications. She got a new doctor who discontinued about half of her prescriptions, and my mother-in-law felt dramatically better and could now afford her prescriptions.

    So the poor woman spent her entire savings, and then some, on meds that only made her feel worse. Grrr!

  8. Connie S
    Reply

    My husband was taking many medications and sustained a series of falls in April and May 2016. While he was in a rehab hospital, I checked his prescription drugs on the internet to find out the side effects of each medicine. Of the drugs he was taking, at least seven indicated that dizziness could be a side effect.

    When he came home after a visit to his primary care doctor, I stopped all medicines, except for his high blood pressure pill. I asked the doctor to run blood tests to include one for B-1. The results showed that he lacked B-1, an essential vitamin that helps brain function. I added that vitamin and many more to his daily supplements. My husband has not had a fall or has been dizzy since taking that large array of prescriptions.

  9. G
    Texas
    Reply

    So glad to see this discussion getting off the ground. My husband was on 5 different meds for high blood pressure and started having irregular heart beats and palpatations and his cognitive level decreased. I noticed he had an abundance of meds and had trouble filling med containers. I asked to take over this task.

    I am convinced he got on multiple BP meds because he was not taking meds and because he has white coat hypertension. Cardiologist stabilized meds and stopped verapamil and HCTZ and ordered amolopidine and within 24 hours BP was much improved.

    PCP haughtily told him perhaps he should seek another doctor. Now, cardio says his BP is ok for his BMI and age, even though PCP thinks it is high.

    The bottom line is include patient and wife as part of the team and stop thinking that one size fits all.

What Do You Think?

We invite you to share your thoughts with others, but remember that our comment section is a public forum. Please do not use your full first and last name if you want to keep details of your medical history anonymous. A first name and last initial or a pseudonym is acceptable. Advice from other commenters on this website is not a substitute for medical attention. Do not stop any medicine without checking with the prescriber. Stopping medication suddenly could result in serious harm. We expect comments to be civil in tone and language. By commenting, you agree to abide by our commenting policy and website terms & conditions. Comments that do not follow these policies will not be posted.

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