Every prescription starts with a reason. But months or years later, that reason may no longer be as clear.
As patients age, develop new conditions and move between healthcare settings, medication lists can grow. In England, around 8.4 million people are regularly prescribed five or more medicines. For many, those medicines remain necessary and beneficial. But for others, the balance between benefit and harm can change over time.
That is where deprescribing comes in. It is not simply about reducing the number of medicines a patient takes. Instead, it involves reviewing whether each medication remains appropriate for that individual and, where the potential harms outweigh the benefits, considering whether it can be safely reduced or stopped.
When Should a Prescription Be Reconsidered?
There is no single trigger for deprescribing. A medication that was appropriate when it was first prescribed may become less suitable as a patient’s health, priorities or circumstances change.
A structured medication review can help clinicians take a closer look at the complete medication picture. That means asking not only what is this patient taking?, but why are they still taking it?
Particular attention may be needed when:
- A medicine no longer has a clear clinical indication or is not providing the expected benefit.
- The risk of adverse effects has increased because of age, frailty, comorbidities or other medications.
- Multiple medicines may be contributing to side effects or creating an increasingly complex regimen.
- The patient’s treatment goals, preferences or circumstances have changed.
Importantly, deprescribing should be a shared process. NHS guidance on medication review emphasises understanding what matters to the patient and involving them in decisions about their medicines. Any decision to reduce or discontinue treatment should also include an appropriate plan for monitoring and follow-up.
Building Confidence Around Deprescribing
Knowing that a medicine should be reviewed can be easier than knowing how to safely change it.
The 30-minute RCP-accredited eCPD course, Optimising Medication Use: A Guide to Deprescribing, takes a practical look at polypharmacy and the deprescribing process, using a patient case to explore how these decisions can be approached in clinical practice.
By completing the course, you will learn how to:
- Describe the potential consequences of polypharmacy.
- Identify patients who may benefit from deprescribing one or more medications.
- Apply evidence-based strategies to safely reduce or discontinue medications where appropriate.