In a patient on many medicines, set aside time to review the whole list against current goals rather than renewing it by default. For each drug ask whether the original indication still holds, whether benefit still outweighs harm at the patient's age and renal function, and whether it is treating the side effect of another drug.
Stop one medicine at a time where you can, so an adverse effect or a return of symptoms is attributable, and tell the patient what you stopped and why. Pay closest attention to drugs with a narrow safety margin in older people: sedatives, anticholinergics, sulfonylureas, and anticoagulant plus antiplatelet combinations that no longer have an indication.
- Review the full medication list against current goals, not drug by drug at renewal.
- For each drug, confirm the indication still holds and benefit still outweighs harm.
- Look for prescribing cascades, where one drug treats another's side effect.
- Stop one medicine at a time and tell the patient what changed and why.
Why it matters
Medicines accumulate by default; removing them almost never happens unless someone makes it a deliberate step.
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