Mr. H is a 78-year-old male presenting to a primary care clinic for a routine medication review. In this scenario, we want to identify deprescribing targets. His past medical history includes hypertension, heart failure with preserved ejection fraction (HFpEF), gastroesophageal reflux disease (GERD), restless legs syndrome (RLS), iron deficiency anemia (resolved), and hyperlipidemia. He lives independently and reports occasional dizziness and fatigue but no recent hospitalizations.
His current medication list includes furosemide 20 mg twice daily, omeprazole 20 mg daily, ropinirole (Requip) 0.25 mg nightly, ferrous sulfate 325 mg daily, vitamin E 400 IU daily, lisinopril 20 mg daily, atorvastatin 20 mg nightly, and aspirin 81 mg daily. Recent vitals are stable, and blood pressure is well controlled. Laboratory values show hemoglobin 14.2 g/dL, ferritin within normal limits, stable renal function, and normal electrolytes.
During the visit, Mr. H reports that his GERD symptoms have been well controlled for several years with no recent heartburn, dysphagia, or GI bleeding. He takes his furosemide doses in the morning and mid-afternoon but notes increased urinary frequency that sometimes interferes with errands. He also states that his restless legs symptoms have been minimal for over a year, and he is unsure if ropinirole is still helping. He is unaware of why he takes vitamin E and believes it was started “for general health.”
A medication optimization plan is developed. Given long-term GERD symptom resolution and lack of high-risk features, omeprazole is reduced to every other day with a plan for discontinuation if symptoms do not recur, using antacids as needed. Furosemide dosing is consolidated to 40 mg once daily in the morning to improve adherence and reduce daytime urinary burden while maintaining volume control. Ropinirole is tapered and discontinued as a trial off therapy, with monitoring for return of restless legs symptoms. Ferrous sulfate is discontinued due to normalized hemoglobin and iron indices, with plans for periodic monitoring (also recall that iron deficiency can lead to RLS – Excellent board exam nugget). Vitamin E is discontinued given lack of clear indication and potential bleeding risk when combined with aspirin.
At follow-up, Mr. H reports improved quality of life with fewer pills, no recurrence of reflux or restless legs symptoms, stable weight and edema, and improved convenience with diuretic dosing. No adverse effects are noted, reinforcing the benefit of regular medication review and deprescribing in older adults.
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