Medication Deprescribing

Deprescribing is the planned, supervised process of reducing or stopping medicines that may no longer benefit a patient or may be causing harm. It is the deliberate counterpart to prescribing, applied especially in older adults whose changing health, goals, and life expectancy can make previously appropriate medicines unnecessary or risky. Deprescribing reframes medication withdrawal as an active, evidence-informed part of good prescribing rather than simply 'doing less'.

Definition

Deprescribing is the planned and supervised process of dose reduction or discontinuation of medications that may be causing harm, or are no longer providing benefit, undertaken with the goal of improving outcomes and aligning treatment with the patient's circumstances and goals.

Scope

The topic covers the definition and emergence of deprescribing, its place as a structured process within medication management, the steps commonly described for reviewing and withdrawing medicines, and the evidence on its feasibility and effects. It is a conceptual and reference treatment; it does not instruct readers on whether or how to stop any specific medicine, which is a supervised clinical decision.

Core questions

• What does deprescribing mean and how did the term emerge?
• How is deprescribing structured as a process rather than an abrupt stop?
• What does the evidence show about the feasibility and effects of deprescribing?
• How does deprescribing relate to identifying potentially inappropriate prescribing?

Key concepts

• Deprescribing as a structured process
• Medication review
• Dose reduction and discontinuation
• Supervision and monitoring
• Withdrawal effects and rebound
• Patient goals and preferences
• Reversing the prescribing cascade
• Shared decision-making

Mechanisms

Deprescribing is generally framed as a stepwise process: compiling a full list of a patient's medicines and their reasons, identifying those that are potentially inappropriate or no longer needed, prioritising which to withdraw, and then reducing or stopping them in a planned, monitored way with attention to possible withdrawal or rebound effects (Scott et al., 2015). Systematic analysis of how the term has been used shows that supervision and the goal of improving outcomes are core to its definition, distinguishing deprescribing from simply omitting a drug (Reeve et al., 2015). The process is closely linked to explicit appropriateness tools, which help flag candidate medicines for review (O'Mahony et al., 2014), and to shared decision-making, since the patient's goals shape which medicines to continue.

Clinical relevance

Deprescribing has become an organising idea for safely reducing medication burden in older adults and is studied as a way to lower the risk of adverse drug events. This entry describes the concept, process, and evidence; it is educational background and is not instruction to reduce or discontinue any medicine, which must be done under clinical supervision because stopping some drugs carries its own risks.

Epidemiology

Research indicates that deprescribing is generally feasible across settings, and a systematic review and meta-analysis found that non-randomised studies suggested possible benefits while randomised trials did not show a clear effect on mortality overall, underscoring that effects vary by drug, population, and design (Page et al., 2016). The evidence base continues to develop, and outcomes depend strongly on which medicines are withdrawn and how.

History

Although clinicians have always stopped medicines, 'deprescribing' as a named, structured concept emerged and spread in the geriatric and pharmacy literature in the late 2000s and 2010s. A systematic review using network analysis traced how the definition converged on planned, supervised withdrawal aimed at improving outcomes (Reeve et al., 2015), and process frameworks set out how to carry it out in practice (Scott et al., 2015). Evidence syntheses then began to test its feasibility and effects in older adults (Page et al., 2016), establishing deprescribing as a recognised counterpart to prescribing within medication management.

Debates

How strong is the evidence that deprescribing improves outcomes?

Deprescribing appears feasible and observational studies suggest benefit, but randomised evidence has not consistently shown improvements in hard outcomes such as mortality, so the size and certainty of benefit remain debated and likely depend on which medicines are withdrawn.

Key figures

• Emily Reeve
• Ian Scott
• Sarah Hilmer
• Amy Page
• Danijela Gnjidic

Seminal works

• reeve-2015
• scott-2015
• page-2016

Frequently asked questions

Is deprescribing just stopping medicines?

No. Deprescribing is a planned and supervised process of reviewing, prioritising, and gradually reducing or stopping medicines with monitoring, aimed at improving outcomes, rather than an abrupt or unmonitored withdrawal.

Does deprescribing always improve outcomes?

The evidence is mixed. Deprescribing is generally feasible and may reduce medication burden, but randomised trials have not consistently shown benefit on outcomes such as mortality; results depend on which medicines are withdrawn and in whom.