Deprescribing

Oct 14, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Do you like the song "Africa" by Toto? Released 1982? Yeah, you've heard it. If you answered, "Yes", you are a terrible person. I'm afraid we can't be friends anymore. Toto's Africa is a sickly sweet, schmaltzy falsetto love ballad that is like stuffing all the worst Hallmark Christmas movies into a meat grinder and putting the extruded goo into a song. Too much synth. Too little soul. Too little feeling. Musical cotton candy. All sweet, no substance. No, I am not a fan. But then, I heard Leo Moracchioli's cover.

Sometimes old things that used to be bad can become good. Like when a cover song is way better than the original. Sometimes something that was good becomes not so good. Like how milk in the fridge becomes bad after three weeks. Deprescribing is a little like throwing out that expired milk. The best explanation I found was on deprescribing.org. "Medications that were good then, might not be the best choice now." Imagine you were put a stomach medication when you were in the hospital for surgery. It is now 10 years later. Is that stomach medication still helping you now? Can you stop it? In fact, can you just stop all your pills?

It is very common for people to ask me if they can be on less pills. They don't like taking pills. They don't like paying for pills. They feel like being on pills makes them look unhealthy. Unfortunately, many of the people I talk also have multiple health conditions. If you have high blood pressure, cholesterol and diabetes, each of those conditions by itself increases your risk of a heart attack or stroke. The best way to prevent a heart attack or stroke is to treat the conditions, and the best treatment is often pills. A 53-year-old male with high blood pressure, cholesterol and diabetes can certainly improve his diet and exercise more to get improve his health. However, it is probably unrealistic for him to expect to be able to safely stop all his pills. But, there are people, especially older people, who have just kind of accumulated medications over the years. Deprescribing might be very good for them.

Deprescribing isn't just randomly stopping meds. Stopping the right meds, the right way can make people healthier, especially as we get older. However, stopping meds should always be done after talking to your doctor and pharmacist. Sometimes stopping a med, even one you don't need anymore, has to be done in specific and slow way to keep someone comfortable and safe. Let's say 10 years ago you were put on the stomach medication omeprazole or losec. Even if you really don't need it now, if you stop it cold turkey, you will get rebound heartburn. Omeprazole should be reduced slowly. Then you probably will need to go on a weaker stomach acid pill like ranitidine for a while. Then the ranitidine will need to be slowly reduced. After this taper, we can safely get you off your stomach medications and keep you comfortable.

Consider a fictious a 74-year-old patient who has type 2 diabetes and let's see if deprescribing will work for him. Let's call him Donald. Donald's son takes him to see the doctor. After talking for a while, the doctor asks if Donald's blood sugar goes low very often. Donald's son says yes and when it does Donald gets dizzy and confused. Donald starts to ramble on incoherently and it seems like his mild dementia really flares up when his blood sugar gets low.

The doctor wonders about drug interactions and sends Donald and his son to talk to the pharmacist. After talking awhile, the pharmacist determines Donald hasn't been eating very much lately. He had a bladder infection. Bladder infections on their own can exacerbate dementia, but in this case, it was the antibiotic Septra. Septra, or trimethoprim/sulfamethozaxole, interacted with one of Donald's diabetes pills, glyburide. The interaction, plus Donald not eating during the bladder infection, probably made his blood sugar go too low. Low blood sugar and dizziness and dementia all increase Donald's risk for a fall. Falls can lead to broken bones and hospitalization. Since Donald's blood sugars are still often low even though the bladder infection is gone, and the antibiotic is finished, the pharmacist asks the doctor stop the glyburide. The doctor agrees and she tells Donald's son to check his blood sugar every day for 2 weeks and call her back with the results. This would be an example of successful deprescribing where reducing the number of pills a patient was on reduced his chances of falling and breaking a bone.

A vocals and synth-ectomy would not have saved Toto's Africa. Apparently, it needed a Metal transplant. I friend at work told me about Leo Moracchioli on YouTube. He is an amazing musician who does Metal covers of many songs. He's done one of the Theme from Frozen, Adele's Hello, Baby Shark, REM's Losing My Religion, Dance Monkey, Robert Palmer's Addicted to Love and many more. Leo Moracchioli's musical surgery turned the broken body of Toto's Africa into an indestructible musical RoboCop. The Metal version has shredding guitars, driving percussion and the gravelly deep growl of a singer who might just have clawed his way out Hades last week. There aren't too many times I lament being bald. But I really wish I had some hair right now for my head banging to Toto's Africa, the good version.

As always if you have any questions or concerns about these products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

deprescribing.org

Leo Moracchioli - Africa - https://www.youtube.com/watch?v=MH9FyLsfDzw

 


Read more Health Articles

Unite Interactive