Most inappropriate polypharmacy in older inpatients is inherited: drugs started for a problem that has resolved, or to treat the side effect of another drug. A quick way to find them is to ask, for each drug, what it was started for and whether that reason still applies.
Common prescribing cascades include calcium channel blocker leading to ankle oedema leading to a diuretic; a cholinesterase inhibitor causing urinary incontinence treated with an anticholinergic; and NSAIDs raising blood pressure treated with an extra antihypertensive.
- For each drug, record the indication; if nobody knows it, question it.
- Look for a new drug started soon after another; it may be treating a side effect.
- Prioritise stopping anticholinergics, sedatives and long-term proton pump inhibitors without a clear reason.
- Write deprescribing decisions clearly in the discharge summary so they are not restarted.
Why it matters
The physician who admits a patient is often the only one who sees the whole medication list at once.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for internal medicine, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free