Deprescribing Opportunities – Case Study

I have had plenty of opportunities in my career to review medications with patients and offer solutions to help reduce their pill burden. Keeping track of taking all these medications can be a full-time job for some of our patients. It is critical that we try to simplify things for them. Here I discuss a brief case and identify deprescribing opportunities to reduce this patient’s medication burden.

An 82-year-old male is seeking to take fewer medications.

Current medications include:

  • Aspirin 81 mg daily
  • Torsemide 10 mg daily
  • KCL 10 meq daily
  • Omeprazole 20 mg BID
  • Sucralfate 1 gram TID
  • Tramadol 50 mg every 6 hours as needed
  • Acetaminophen 500 mg TID
  • Glucosamine 1500 mg daily
  • Amlodipine 10 mg QD
  • Clonidine 0.1 mg BID
  • Lisinopril 5 mg daily
  • Metoprolol 25 mg BID
  • Ropinirole 0.25 mg at bedtime
  • Atorvastatin 80 mg daily
  • Cyclobenzaprine 10 mg at bedtime
  • Zolpidem 10 mg at bedtime
  • Gabapentin 300 mg TID
  • Alprazolam 0.25 mg BID PRN anxiety
  • Loratidine 10 mg daily
  • Melatonin 5 mg HS
  • Vitamin E 400 units daily

There are plenty of deprescribing opportunities when looking at this list. When reviewing medications with patients, diagnoses are going to be important. For instance, if he has Barrett’s esophagus, we would be much less likely to be able to reduce the PPI.

Here are my targets to inquire about and possibly reduce this gentleman’s pill burden.

I don’t like the blood pressure regimen. Low doses and agents that aren’t very friendly (i.e. clonidine). I’d love to consolidate and remove some of these agents. It is possible the clonidine is being used for another diagnosis so I’d have to review that, but that would be my first to go. I’d also inquire about the torsemide use and if medications are contributing to edema such as amlodipine or gabapentin.

If edema is found to be an adverse effect, this might allow us to stop the torsemide. If the torsemide is stopped, it would also be possible to stop the potassium supplement (depending on the lab value).

Pain appears to be a big issue for this patient. I’d love to taper/DC the cyclobenzaprine or gabapentin. Ropinirole would also be a target if the patient is set on sticking with cyclobenzaprine and gabapentin. Glucosamine probably isn’t doing much if he still needs tramadol and acetaminophen. This could be an easy target for DC if the patient didn’t feel it was effective.

Controlled substances make me nervous as well. I’d love to address zolpidem need, alprazolam, and tramadol use.

GI medications should be reviewed as well. I would ideally like to start with a taper of sucralfate to twice daily if the patient is on board with that.

Vitamin E can be discontinued for most patients as well.

What else would you address in this medication list that I missed?

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  1. Jess W

    What is patients CVD risk and bleeding history? can we consider stopping aspirin?

    • Eric Christianson

      Good question!

  2. Wahu Oseso

    melatonin vs zolpidem. does he need both?


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Written By Eric Christianson

November 22, 2023

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