Stopping medication: A viable option?
Stopping medication: A viable option?
Withdrawal adverse events are low in study
While taking patients off drugs to reduce errors or interactions may sound simplistic and potentially harmful itself, a recent study of 124 elderly outpatients found that 74% of the discontinued drugs analyzed did not result in patient adverse drug withdrawal events (ADWEs).1
Further, more than 80% of the 238 types of discontinued medications were not restarted or replaced in the study’s patient group, limited to those 65 or older taking five or more drugs on a regular basis.
Although the majority of the drugs were stopped without incident, the study notes that at least one ADWE did occur in just under a third of the patients, resulting in simple clinical intervention, restarting or replacing medication, or emergency hospitalization, depending on the types of reactions and maintenance regimens in place.
For the overall one-year study, researchers found that adverse withdrawal events can occur at any time up to four months after a drug has been stopped, while the average time it took for an ADWE was 35 days. But the researchers stress that heightened patient monitoring should continue for four months.
A reaction was considered an ADWE if it was new, recurrent, or increasing in severity or duration. Types of ADWEs and reaction times were defined as either physiological and occurring within two weeks (or four weeks for B-blockers and benzodiazepines) or as a worsening medical condition occurring within four months.
During the study, 238 drug orders were stopped among the 124 patients. Of those, 62 (or 26%) resulted in 72 potential ADWEs in 38 patients. Of the potential ADWEs, 26 (or 36%) resulted in hospitalization or an emergency department (ED) admission, with 13 patients designated in the "major" ADWE category of prolonged hospitalization, ED admission, disability, or death.
The largest percentage of ADWEs, 42%, were tied to the discontinuation of cardiovascular drugs, particularly B-blockers, while 18% of adverse withdrawal events were tied to central nervous system drugs, particularly benzodiazepines. The study’s authors recommend that patients be gradually tapered off these classes of drugs rather than simply discontinued.
In contrast, stopping gastrointestinal, respiratory tract, and musculoskeletal drugs resulted in much lower numbers of adverse events. And when an ADWE did occur, in 76% of the cases the drugs in question were simply restarted or replaced with positive results.
Overall, the study points out that the great majority of ADWEs, 88%, were attributed simply to "exacerbations of underlying disease." And finally, the authors recommend that "practitioners pursue the desirable goal of discontinuing the use of unnecessary or potentially harmful drugs but with vigilance for disease recurrence, particularly with cardiovascular and central nervous system agents."
Reference
1. Graves T, Hanlon JT, Schmader KE, et al. Adverse events after discontinuing medications in elderly outpatients. Arch Intern Med 1997; 157:2,205-2,210.
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