Which Medications Should be Discontinued in Hospice Patients?

A 95 year old female has recently entered a hospice program.  Whenever a patient is enrolled in hospice, it is very important to assess the medication regimen and identify medications that are no longer necessary.  Quality of life is the top goal when a patient is on hospice.  I often get asked which medications should be discontinued in hospice patients, so here’s a med list with my thought process.

  • Aspirin 81 mg daily
  • Oxybutynin 5 mg daily
  • Ativan 0.5 mg twice daily as needed
  • Morphine 10 mg three times daily as needed
  • Artificial Tears as needed
  • Simvastatin 20 mg daily
  • Vitamin C 500 mg twice daily
  • Alendronate 70 mg weekly
  • Calcium with Vitamin D 500mg/400 units twice daily
  • Hydrochlorothiazide 12.5 mg daily

When looking at a hospice patient, the goal is comfort.  I would be looking at those medications that take a long time to provide benefit, or are preventative in nature.  Here’s the obvious ones for me:

  1. Simvastatin – Statins are preventative in nature and not necessary if the goal is comfort and life expectancy is short (i.e less than 6-12 months).
  2. Alendronate and Calcium/D – Again, preventative medication that helps osteoporosis. Alendronate and calcium/D will not provide any comfort for our hospice patient.
  3. Vitamin C would be an interesting one depending upon the indication. Some patients feel that it can really help them with preventing bladder infections.  I’m not too sold on the clinical literature with regards to that benefit, but definitely something that I would want to assess with the patient and/or caregiver.  I would lean towards discontinuing without a strong opinion from the patient/caregiver.
  4. Aspirin can be a tricky one as well. The antiplatelet effect will go away after a few days if discontinued and can lead to some pretty serious consequences.  It would be important to get the patient’s perspective/wishes on this medication, but in general, I typically don’t recommend discontinuing aspirin in patients who have significant cardiac or stroke risk.
  5. I would like to take a good look at blood pressure as well to assess the low dose hydrochlorothiazide need.

Is there anything else you would like to add from your experience?

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Written By Eric Christianson

June 19, 2016

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