I’ve been collecting examples of situations where a patient is “stable”, and a provider doesn’t want to change medications. Stable is good, right? It is, but it can also lead to providers not wanting to reduce medications and change anything. If we only tapered medications when things were going poorly, patients would rarely get off unnecessary medications. It can be uncomfortable to want to change things when the patient is “stable”, but never reducing a medication when the patient’s clinical status is ok will ultimately increase the likelihood of polypharmacy. Here are 3 case examples of situations where the provider did not want to reduce medications because the patient was “stable”.

1. A 77-year-old female had a history of GERD but had no recent GI complaints. Her hemoglobin was normal, and she was not taking any anticoagulant, antiplatelet, or NSAID medications. The dose of omeprazole was 40 mg twice daily. The provider did not want to reduce the medication because she was stable with no symptoms.
2. A 66-year-old male had a history of RLS and was treated with ropinirole 1 mg at bedtime for years. A reduction to 0.5 mg at bedtime was requested. The provider did not want to reduce the medication because the patient was stable.
3. A 71-year-old female had a knee replacement 6 months ago that led to significant blood loss and the prescription of an iron supplement. Hemoglobin at the time of surgery did get slightly below 10. Now, the patient’s hemoglobin was well within normal limits, and she did not require iron supplementation prior to the surgery. Iron stores and labs were within normal limits. The provider did not want to discontinue iron because the patient was “stable” and doing well.

These are all classic examples where the risk for polypharmacy and overprescribing could be addressed, but weren’t. I would encourage both patients, providers, nurses, pharmacists, and other healthcare professionals have a willingness to try to reduce medications whenever possible. Many medications can have long-term side effects or contribute to drug interactions, and if we don’t change anything when patients are “stable”, these patients will end up with long medication lists and future unintended consequences.

What other situations have you seen where medications weren’t reduced because the patient was stable?

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