Sunday, July 30, 2023
Deprescribing is the process of safely reducing or stopping overly complex medication regimens. There is a wide range of reasons why patients are considering coming off medications. For some, it may be a personal choice, for some a medical necessity. Certain combinations of poly-pharmacy may have uncomfortable side effects. High risk medications may cause potential harm.
For many varied reasons, doctors and patients are making a move to deprescribe medication. This strategy is meant to be beneficial and help prevent potentially negative consequences of polypharmacy, such as adverse drug reaction and other potential risks. It is also meant to reduce the burden of treatment for people with chronic conditions, especially relevant for adults with polypharmacy who are at higher risk of drug interactions and adverse outcomes.
Deprescribing is not a simple task. It requires systematic review of medication regimen, shared decision-making process between patients and health care practitioners, and a careful monitoring of reduction or cessation of medications. It also involves overcoming various barriers, such as patient preferences (patient barriers) and clinician attitudes.
In this blog, we aim to explore the different aspects of the deprescribing movement, such as:
- The prevalence of poly-pharmacy and inappropriate medication use in different clinical settings
- The evidence for deprescribing and the classes of medications that are commonly targeted
- The approaches to deprescribing and the guidelines that support deprescribing decisions
- The benefits and risks of deprescribing and the factors that influence the outcomes
- The attitudes and perceptions of patients and health care practitioners towards deprescribing and the barriers and enablers of deprescribing
- The alternate treatments and interventions that can complement or replace prescription medications in some cases
- The role of pluripotent stem cells and Plurisomes™ in enhancing health outcomes in the context of deprescribing
Prevalence of Polypharmacy
There is a widespread issue of polypharmacy and inappropriate medication use all over the world.
Polypharmacy is defined as the concurrent use of multiple medications, usually five or more, by a single individual.
Inappropriate medication use refers to the use of medications that are not indicated, effective, safe, or acceptable for a given patient or condition.
Approaches to polypharmacy and inappropriate medication use can increase the risk of adverse drug events, such as drug interactions, adverse effects, medication errors, and non-adherence. They can also negatively affect health outcomes.
According to a systematic review and meta-analysis by Tian et al. (2022), the prevalence of overprescription among older lung cancer patients was 35% and 38%.
Another systematic review and meta-analysis by Delara et al. (2022) estimated use of polypharmacy among individuals over 19 to be 37%, with higher rates reported in older adults and inpatient settings.
These findings indicate that polypharmacy and inappropriate medication use are common and complex phenomena that require careful assessment and intervention by health professional experts. Deprescribing can be a valuable approach to reduce unnecessary medications and optimize health overall.
Evidence for Deprescribing
Evidence for medication regimen reduction is vast, adverse drug event and interactions are widely known in scientific literature (even clinical trial evidence) and clinical settings. It is not the scope of this blog to dive deep into these.
One thing that is key to note, however, is that some classes of medications are more frequently targeted for deprescribing than others, either because they are over-prescribed, have a high risk of adverse drug effects, or have limited potential benefits.
Examples of such classes include cardiovascular drugs, antihypertensive medication, antidepressant medication, benzodiazepine medication, anticholinergic medications, other psychotropic medication types, cognitive decline supportive medications, and other common long-term medications like proton pump inhibitors (PPIs), antihyperglycemic agents.
To support changes to prescription medications, clinicians use evidence for deprescribing and design reliable evidence-based guidelines in their clinical practice.
Deprescribing has potential benefits and risks that need to be carefully evaluated. Once a formal medication review is made, you and your clinical care team can consider the balance of benefits and harms of continuing or discontinuing your regular medications.
Benefits of deprescribing current medication may include reducing medication side effects, lowering prescription drug costs, enhancing quality of life, and prolonging survival. The goals of care are always meant to be positive. Deprescribing should be a positive treatment option for you.
The deprescribing process can at times be a negative experience. The burden of treatment may include exacerbating symptoms or medical conditions, inducing withdrawal symptoms, or necessitating the resumption of medicines. Counter medications or alternatives may need to be introduced to override negative outcomes. Successful implementation needs to keep the benefit ratio in your favor.
The outcomes of deprescribing are influenced by multiple factors, such as your age, your clinical condition, chronic conditions, the types of prescription medications you take, the duration of use, the method of adjustment, and the monitoring of effects.
Deprescribing is mostly conducted in general medicine health care settings, primary care settings, and acute care setting environments (ex: acute care hospitals). Long-term care centers more tightly bound to strict geriatric medicine standards of care and medication regimen changes for medical patients less flexible.
Attitudes Toward Deprescribing
Deprescribing is not only a clinical decision, but also a shared decision that involves patients and health care practitioners. Therefore, it is important to understand common perceptions.
Some of the common facilitators to deprescribing include having a good patient-provider relationship, having clear communication and education about the benefits and risks of deprescribing, having evidence-based guidelines and tools to support deprescribing decisions, and having regular medication reviews to monitor the effects of deprescribing.
Some of the common patient barriers and clinician barriers include having limited time and resources, having conflicting or unclear information about medications, having fear of negative outcomes or withdrawal symptoms, having resistance or reluctance from patients or providers, and lacking coordination or continuity of care.
Approaches to Deprescribing
Deprescribing means stopping or lowering the dose of some medicines that you may not need anymore or that may cause you more harm than good. This can help you feel better, avoid side effects, and save money. But deprescribing is not always simple. It requires a systematic process. Primary care physicians generally follow Beers, STOPP, and START lists, and the Medication Appropriateness Index.
You can also look for other options and opinions that have beneficial effects in patients. For example, you can talk to other health care provider specialists who have different ways of looking at health, such as functional, naturopathic doctors. They may suggest ways to lower your dose gradually and replace it with nutraceutical, botanical approaches or therapies that can support your body and mind. They may also help you deal with any side effects or withdrawal symptoms that you may experience during deprescribing.
Alternative treatments and interventions tend can complement and in some cases replace prescription medications. Alternative treatments and interventions can be classified into three broad categories:
- Functional approaches using nutraceuticals and botanicals: These are approaches that use non-pharmaceutical substances, such as vitamins, minerals, peptides, herbs, or plant extracts, to provide nutrients, prevent deficiencies, or treat conditions.
- Bioenergetic approaches using biophysics, currents, meridians, and homeopathy. These approaches use the principles of physics, energy, or vibration to stimulate or balance the body’s natural healing processes.
- Biological approaches using biological products like stem cells and PRP. These are approaches that use living cells or tissues, such as stem cells, exosomes or platelet-rich plasma (PRP), to repair or regenerate cells, tissues and organs.
Pluripotent Stem Cells and Plurisomes™ in the Deprescribing Process
Pluripotent stem cells and their secreted exosomes, Plurisomes™, are capable of signaling repair, bioregulation and reprogramming in all 220+ tissue types of the body. This is very unique in the field of stem cell medicine. Mesenchymal stem cells signal repair in about 8 tissue types, offering support to key musculoskeletal tissues especially.
Pluripotent factors are able to offer such support to all tissues and organs, the heart, the lungs the liver, the brain and the nervous system, all the glands and functional systems such as endocrine system and immune system. If you need whole body repair and rebalancing, Pluripotent stem cells and Plurisomes™ are the best biological medicine for that purpose.
In the deprescribing process, we need to support all the systems of the individual patient. When you take a the human body off medication, the biogregulatory capacity of the body gets altered and many systems are affected all at once. Adverse events can occur from these sudden changes. Using pluripotent stem cell therapy in deprescribing can help safe reductions and even complete cessation of prescription medication.
At the Stemaid Institute, we receive adults ages 18-95, some coming in with common long-term conditions with complex medication regimens (ex: elderly patients and chronic non-cancer pain patients). Their prescriptions include cardiovascular drugs, cardiovascular medication, antihypertensive medication, antidepressant medication, tricyclic antidepressants, benzodiazepine medication, other psychiatric medications for metal health and cognitive impairment, and other common long-term medications like proton pump inhibitors (PPIs), antihyperglycemic agents for blood sugar regulation, and medications for weight loss.
Formal medication review is conducted for each patient and if the care goal includes reduction or cessation of medications, we create a treatment alliance with the patient and their prescribing health professional. Successful implementation requires medication regimen reviews, a clinical reason for deprescribing, practitioner empathy towards patient beliefs and needs, and continuity of care after stem cell treatment.
Benefits of treatments with Pluripotent stem cells and Plurisomes™ have a wide range. Clinical outcomes we witness every week at Stemaid Institute are positive overall and tend to benefit all systems and organs of the body. The deprescribing process requires full body reparative physiological support. The brain, the cardiovascular system, the liver and gallbladder, the digestive system, the endocrine and immune systems all need to be onboard to help the body bioregulate back to a healthy state.