Dose reduction is a reasonable aim for many stable patients troubled by side effects, but relapse risk rises after reduction and can come quickly. The safest reductions are gradual, agreed with the patient and family, and come with a plan for what early warning signs look like and who to call.
Write down the patient's own relapse signature - the first changes they or their family noticed last time - and schedule closer review during and after each step down.
- Reduce gradually, in small steps with time to stabilise between them
- Record the patient's personal early warning signs from previous relapses
- Agree in advance who the patient or family contacts if those signs appear
- Increase review frequency during the reduction and for months afterwards
Why it matters
Most harm from deprescribing comes from relapse that is noticed late.
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