title: Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action.
abstract: Deprescribing can be defined as the process of withdrawal or dose reduction of medications which are considered inappropriate in an individual. The aim of this narrative review is to provide an overview of "deprescribing"; firstly discussing the potential benefits and harms followed by the barriers to and enablers of deprescribing. We also provide practical recommendations to recognise opportunities and strategies for deprescribing in practice. Studies focused on minimizing polypharmacy indicate that deprescribing may be associated with potential benefits including resolution of adverse drug reactions, improved quality of life and medication adherence and a reduction in drug costs. While the data on the benefits is inconsistent, deprescribing appears to be safe. There are, however, potential harms including return of medical conditions or symptoms and adverse drug withdrawal reactions which emphasise the need for the process to be supervised and monitored by a health care professional. Taking action on deprescribing can be facilitated by knowledge of potential barriers, implementing a deprescribing process (utilising developed tools and resources) and identifying opportunities for deprescribing through engaging with patients and caregivers and other health care professionals and considering deprescribing in a variety of populations. Important areas for future research include the suitability of deprescribing of certain medications in specific populations, how to implement deprescribing processes into clinical care in a feasible and cost effective manner and how to engage consumers throughout the process to achieve positive health and quality of life outcomes.
authors.affiliation: NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW, Australia; Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Capital Health, Nova Scotia Health Authority, NS, Canada. Electronic address: emily.reeve@sydney.edu.au.
authors.forename: Emily
authors.initials: E
authors.lastname: Reeve
authors.affiliation: Bruyère Research Institute, Ottawa, ON, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, ON, Canada.
authors.forename: Wade
authors.initials: W
authors.lastname: Thompson
authors.affiliation: Bruyère Research Institute, Ottawa, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada; School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Farrell
mesh_terms: D000368:Aged; D000069340:Deprescriptions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology; D006801:Humans; D055118:Medication Adherence; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013375:Substance Withdrawal Syndrome
keywords: Deprescribing; Inappropriate medication use; Medication withdrawal; Narrative review; Older adults