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When is the Right Time to Change and Discontinue Medications?


Polypharmacy is defined as the regular use of five or more prescriptions taken daily by one patient. This is common in those that are 65 and up with multiple medical conditions. Most of these patients do not realize that at least one of their medications could be discontinued with the right care and health plan. A study from the Lown Institute shows that 42% of older adults take five or more prescription medications a day. Lown Institute identifies 3 big drivers of medication overload:

  1. Culture of Prescribing – Whenever a medical issue arises like diabetes, high blood pressure, etc. then it can be a patient’s immediate reaction to find a pill that can solve the issue. The problem with this is that our society has become so pill happy that even physicians are not reviewing a patient’s current prescriptions to decide if they can discontinue any.

  2. Information and Knowledge Gaps – Both physicians and patients lack the information to make informed decisions about medications. Pharmacists are the medication experts and the most qualified to be making decisions on the management of your prescriptions.

  3. Fragmentation of Care – There is a disconnect with communication between a patient’s multiple physicians. This disconnect leads to physicians prescribing medication to what they believe is a “new” condition, when in reality it is the side effect of another prescription they are taking. This is known as the prescribing cascade, when one drug is prescribed to help with the side effect of another drug. Care coordination is extremely important when you are taking multiple medications between multiple physicians. Read here why you should have an appointed care coordinator to walk alongside you in your health journey.


How do you know if you are taking a drug that can be discontinued/changed?

The National Library of Medicine lists a few indicators that you should watch out for that will let you know if you need to change or discontinue your medication.


Indications that may warrant changing the drug regimen include:

  • Worsening symptom or condition

  • Medication-related adverse effect

  • Poor medication adherence or compliance

  • Excessive out-of-pocket expenditures

  • Mandated therapeutic substitution

Indications that may warrant discontinuing a medication include:

  • Diminished benefit, such as cases of clinical improvement or stabilization

  • Increased risk, such as medication-related adverse effects, drug interactions, and unsafe use such as high-risk drugs in older adults.


Next Steps

Step 1 - Talk to your physician if you notice an indication to discontinue a prescription.


Step 2 - Explain exactly what indications and symptoms you are noticing so the physician can identify and prioritize the medication(s) that need to be targeted for discontinuation.


Step 3 - Set up a discontinuation plan to communicate and coordinate with your physician.


Step 4 - Be monitored by your physician for beneficial or harmful effects.


Make sure to keep your doctor informed if you start to notice any major side effects after discontinuing or changing your medication. Dr. Gary Blanchard of Saint Vincent Hospital states that “It becomes easy to add medications…but it’s much harder to subtract it.” It will take time to adjust when discontinuing a medication. It is possible, but you will have to be committed to trusting and following through on your physician’s care plan for you.


Tria Health Can Help

Tria Health is a no cost benefit available through select members’ health plans. Tria Health’s Pharmacy Advocate Program offers one-on-one, private consultations with a Tria Health Pharmacist. During your consultation, your pharmacist will review all your current medications, including vitamins and supplements. Tria Health will assist you in identifying any possible drug interactions, possible medications you could discontinue, and savings opportunities! Your pharmacist will work with you and your doctor(s) to ensure the intended outcomes from your medications are being received.


Questions?

Contact the Tria Health Desk at 1.888.799.8742


Resources

  1. https://lowninstitute.org/projects/medication-overload-how-the-drive-to-prescribe-is-harming-older-americans/

  2. https://knowablemagazine.org/article/health-disease/2021/tackling-growing-problem-of-overmedication

  3. https://www.wbjournal.com/article/seniors-are-being-overmedicated-as-momentum-grows-to-de-prescribe-patients

  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119470/