15th October 2025

Deprescribing: Information for clinicians

This advice is sourced from Dr Clifford Lisk and Dr Ros Taylor

Polypharmacy increases the risk of falls, delirium and drug interactions, all leading to hospital admission. It can also worsen frailty.

Medicines are prescribed for 3 reasons:

prevention of future harm
control of illness
symptomatic relief

Consider the original reason for each medication - then review whether it still has any symptomatic benefit - or whether it may now be causing harm.

Medications to consider stopping:

Class of medicine	Examples	Reasons to consider stoppping	Cautions/notes
All		Any drug that the patient doesn't take, can't swallow or doesn't tolerate.	Review indication
Anti-anginals	GTN, Isosorbide mononitrate	If no angina symptoms (these often reduce in advanced illness as people move less)	Ensure patient still has access to GTN spray for acute symptoms. Monitor for recurrence of angina.
Anticoagulants and anti-platelets	Aspirin, Clopidogrel, Warfarin, DOACs (eg Apixaban), LMW heparin injections	Avoid anti-platelet agents if only for primary cardiovascular prevention. Stop anticoagulation where risk of bleeding outweighs the risk of clots (e.g in the case of a GI tumour)	Stopping anticoagulation/assessing bleeding risk is often a difficult decision which is best made with colleagues. Consider using HAS-BLED to assess risk.
Anticholinergics	Oxybutinin, Buscopan, Chlorphenamine, Amitriptyline	Side effects include falls, dry mouth, constipation and confusion.	Note the overall anticholinergic burden and whether some drugs can be omitted safely.
Anti-arrhythmic drugs including beta-blockers	Bisoprolol, Carvedilol	Can cause hypotension Contribute to fatigue	If symptomatic tachycardias are present, or if a betablocker is also helping angina, it may be advisable to continue treatment.
Antihypertensives	ACE Inhibitors and ARBs, Alpha blockers, Diuretics, Calcium channel blockers eg Amlodipine	Blood pressure often reduces with advancing illness, and hypotension causes fatigue and falls. Stop ACEi/ARBs that are used solely for renal protection (e.g in diabetes).	Diuretics in heart failure usually need to be continued.
Dementia medications	Antipsychotics, Aricept, Memantine	Consider reducing doses of antipsychotics if level of distress is low. Aricept and memantine may cause falls and insomnia and should be reviewed in advanced disease for benefit vs harm.	Some dementia medications should be tapered rather than stopped suddenly.
Cardiac glycosides	Digoxin	Impaired renal function can cause Digoxin toxicity (nausea, visual disturbance, arrhthmias) Can contribute to hypotension and fatigue	Provides symptom relief in heart failure. Narrow therapeutic window; monitor renal function and electrolytes. Watch for signs of toxicity
Osteoporosis treatments	Bisphosphonates and Calcium supplements	Unlikely to be of benefit in the short term. Weekly Alendronate can cause painful oesophageal ulceration
Proton pump inhibitors and H2 receptor blockers	Lansoprazole, Omeprazole, Famotidine	Should not be required at full therapeutic dose without a current indication (e.g for symptoms or gastroprotection)	May be required if on steroids or NSAIDs.
Oral hypoglycaemics	Metformin, Sulphonylureas, Gliptins, Glitazones	Prevention of future diabetic complications is no longer relevant. Aim for monotherapy if any therapy is needed.	Aim for blood sugars 6-15
Lipid lowering treatments	Statins, Ezetimibe, Bile acid sequestrants, Fibrates	Unlikely to be of benefit in the short term
Supplements	Iron, Folate, Multivitamins	Rarely relevant towards the end of life and add to the tablet burden.

Top tips:

Review inhaler technique - these are often not properly used in advancing illness and can be stopped
Useful phrase "Some of your medicines that used to help you may no longer be of benefit''
Focus on the benefits of stopping rather than the futility of continuing
Always ask about 'over the counter' and herbal medicines
If a catheter has been inserted review the need for bladder related medicines