Deprescribing Medications

Quite a paradox coming from a pharmacist right? Deprescribing is the act of discontinuing a medication. Why? All medications can have side effects – known and unknown.

As pharmacists, we aren’t charged with simply advocating safe medication usage. We also are to look for unnecessary prescriptions. The term polypharmacy is used to describe the situation where a person is on multiple medications, sometimes even adding meds because of side effects others caused.

Diseases from a lack of prescriptions?

My frame of mind on this topic is simple: does a depressed patient have a Prozac deficiency? Or a person with high cholesterol a Lipitor deficiency? Probably not. Does that mean we should not use or stop prozac immediately? No, many medications such as Prozac can provide benefits. Same with those targeted at cardiac and blood pressure. However, standards of care dictate chronic use of many Rx’s. How are these standards of care performing? Not great looking at current health trends..

Considering Deprescribing Chronic Prescriptions

Understanding both the pharmacology and underlying contributors to various conditions, I am in a unique position to develop strategies to deprescribe your daily prescriptions. And not at the expense of health, but to the benefit of how you feel and perform. It is rare that long-term prescriptions make you “feel” better, rather patients accept the side effects as status quo.

Medications and our health care system have successfully increased lifespan. The same cannot be said for healthspan – the duration of time you live in good health. The last number of years sustained by intense medication regimens accomplishes life extension, but healthspan typically does not see benefit.

Harsh assessment? Sure, but real.

Where To Start?

These are the medications I would start with, but please reach out if you want to work your way off these or any any others. Again, this should be done with medical supervisions.

Proton Pump Inhibitors (PPI’s) / Acid Suppression

Acid reflux is most often NOT caused by excessive acid, rather insufficient acid production – read this free whitepaper. Decreasing stomach acidity impairs microbial defense, degrades the ability to digest proteins, impairs vitamin and nutrient absorption (B12 and magnesium especially), among other effects.

These medications were originally to be only short term, however I see people on them for years. This is unfortunate.

Depression / Anxiety

Do NOT stop these medications without medical supervision. Discontinuation done the wrong way could have serious consequences.

A variety of contributors are part of the development of depression / anxiety. We can deploy strategies to impact these root causes while evaluating the appropriateness of a discontinuation strategy.

Often time brain inflammation is involved in these conditions. I happen to have a 30 page paper on tactics helpful in reducing this inflammation – I have seen this information help people dramatically.

Statins

Cholesterol is important in countless areas of the body. Yes, it is found in plaques involved with cardiovascular disease (CVD). However, targeting the entire body’s ability to make cholesterol is not without consequences. The pathway statins interrupt also blocks other important endpoints such as Vitamin K, ketone production, DNA, and more. Further, cholesterol is step #1 in the synthesis of many hormones including Vitamin D (yes it is a hormone) and the sex hormones. Interestingly, the brain must make its own cholesterol because it cannot obtain from the circulation. Certain statins impact this brain production more than others, which is important to know to avoid the reported dementia type effects associated. Then, we have to look at how effective statins are at preventing CVD. Newer evidence suggests they are not effective agents in this area, even though they do bring down cholesterol lab measurements.

Check out my 100 page whitepaper on Deprescribing Statins Here.

I have helped deprescribe statins, and the results have been good in conjunction with other measures to improve cardiovascular health. These patients feel better and their cholesterol markers maintained in target zones. Don’t stop your statins immediately, this approach is best when working collaboratively with you healthcare provider. I am more than happy to help…free intro call here.

Insulin

Deprescribing insulin is beneficial in all cases – financially and biologically. Type II diabetes is NOT a case of deficient insulin (period). Rather, it is caused by overloading our cells with so much glucose (blood sugar) that they cannot accept any more. Enter insulin. A good analogy I heard recently was someone shoving clothes into a suitcase that was full and having to sit on it to get the latches closed. Same thing at the cellular level with insulin; one of its roles is to activate glucose entry into the cell – ONE of its roles. Insulin is a major growth signal in the body. This is good at times, but chronic growth signaling is associated with cancer, cardiovascular disease, and many chronic conditions. I wrote a 20+ page paper on why avoiding insulin is so important, but there is enough information here to justify deprescribing insulin ASAP.

Where to go next

These are just a few of the drug classes I look at first to deprescribe. There are better ways to achieve health than using these medicines long term. Again though, please do not just stop and see how it goes. We can work together with your prescriber to come up with a plan to move forward. Often it must include other actions to improve outcomes. Please reach out to get started on these or other medications you may want to discontinue safely while improving health and saving money.

Further Reading

Whitepapers:
Avoiding Insulin in Type 2 Diabetes
Addressing GERD by Increasing Acidity?
Deprescribing Statins