In healthcare training, most of the focus is understandably placed on diagnosing conditions and starting the right medicines. But in real-world practice, many patients—especially older adults—gradually accumulate long medication lists. What often receives far less attention is the equally important question: when should a medicine be stopped?
This is where deprescribing comes in. At its core, deprescribing is the thoughtful, supervised process of tapering or discontinuing medicines that may no longer be necessary, beneficial, or safe for a patient. It is not about randomly stopping therapy; it is about reassessing ongoing need in the context of the patient’s current clinical status.
With rising life expectancy and multimorbidity, polypharmacy has become increasingly common. Over time, some medicines started years earlier may continue by default rather than by active decision. The risks are well known—drug–drug interactions, cumulative adverse effects, pill burden, and reduced adherence.
Yet deprescribing is still not routinely embedded into many clinical workflows. Part of the hesitation is understandable: fear of disease relapse, uncertainty about responsibility, and lack of clear protocols in some settings. It often feels safer to continue than to reconsider.
However, careful medication review can uncover opportunities to simplify therapy without compromising outcomes. Pharmacists, physicians, and nurses all have a role to play in identifying medicines that may warrant reevaluation.
As healthcare shifts toward more patient-centred care, perhaps the real mark of good prescribing is not just knowing what to start—but also knowing when it is appropriate to step back.
In your practice or training, how often do you actively look for opportunities to deprescribe?
MBH/PS