Every time I see a patient in my office I review in detail the medications the patient is taking. My office staff and I obsessively work on making sure the list I have in my electronic medical record matches exactly what the patient is taking.
As I review the medications I am asking myself the following questions:
Does the patient need this medication?
Is he/she having side effects from the medications?
Is this the right dosage?
Are there any interactions between the medications that are important?
Is there a cheaper or safer alternative?
For many patients, I will reduce or stop what I consider to be unnecessary medications. Often this results in the patient feeling better, sometimes this is live-saving.
Dr. John Mandrola (electrophysiologist and former colleague of mine in my former cardiology practice in Louisville, KY) writes an excellent blog at DrJohnM.org and has recently encouraged us all to ponder deprescribing, a verb that describes the process of stopping potentially inappropriate medications.
I encourage you to read his post (here) on deprescribing and his other informative posts on topics related to reducing inflammation in our lives, atrial fibrillation and cycling .
Since putting this post together, I saw a patient in my office whose mother would greatly benefit from deprescribing. My patient and I had in previous visits mutually decided that he did not need to be on a statin drug as he had had myalgia side effects from Lipitor and when we looked at his carotid artery it was not abnormally thickened and had no plaque. He asked me if his 95 year old mother (who is not my patient) should be taking Welchol and Zetia.
Zetia is a very expensive, brand name cholesterol lowering drug that has never been shown to improve cardiovascular outcomes despite effectively lowering the LDL or bad cholesterol. I never prescribe it.
Welchol is an expensive, brand name cholesterol lowering drug which has I only use in patients who have markedly elevated LDL cholesterol levels and evidence of marked atherosclerosis. It commonly causes constipation. I rarely prescribe it.
The data for treating cholesterol in patients over age 75 is lacking and by the time patients reach age 95 the risks of these drugs likely outweigh any benefits.
I think my patient’s 95 year old mother would greatly benefit from a healthy dose of deprescribing!
The skeptical cardiologist typically spends many hours a week scanning scientific publications, looking at past research, and analyzing relevant cardiovascular information. Within a few minutes