On a previous post, I laid out some strategies to reduce medication use. As a consultant pharmacist who has worked extensively in long term care and assisted living, I am routinely asked if we can reduce someone’s medications. Reducing medications is something I consider in virtually every patient I work with. Here are more pearls on this topic and Part 2 of Strategies to Reduce Medications.
Drugs Used With Other Drugs
Reducing medications also involves reviewing intentional use of the prescribing cascade. A few examples where we add a drug to manage potential adverse events include:
- Folic acid with methotrexate
- Potassium supplements with diuretics
- Stool softener/laxatives with opioids
I’ve seen all of these examples happen. The original drug (i.e. the diuretic) is discontinued and the drug intended to help prevent adverse effects (
Reduction in Pill Burden
Another strategy to reducing the medication burden is to look at drugs that are dosed frequently. Hydralazine and clonidine are two recent examples that come to mind when trying to reduce medications. Clonidine is usually dosed twice daily, although I have seen three times per day. Hydralazine is an antihypertensive that is often dosed 3-4 times per day. Raising the dose of another blood pressure medication or identifying an alternative that can be given less often can help us reduce the total pill burden.
This is kind of low hanging fruit and pretty easy to do. Patients who have numerous pill bottles at their home or an excessive number of medications on their med list can be overwhelming for patients, nurses, providers, and pharmacists. Getting rid of some of those PRN’s can help us see a little more clearly and at least help us feel that we are making some progress in stopping polypharmacy. In Long Term Care Consulting, this may actually help prevent survey deficiencies as well. You can find my entire course on LTC Consulting here.
Multiple Low Dose Drugs to Treat One Condition
Hypertension is the diagnosis that comes to mind when I think about this strategy. A patient on lisinopril 2.5 mg daily, metoprolol 25 mg BID and amlodipine 5 mg daily could possibly get away with just one drug, or at least two by using higher doses of the other agents. This is a strategy to reduce medications, but you have to remember that compelling indications are very important as to why a patient might be on many of the antihypertensives.
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