Synopsis
Plan safe, shared and reversible medicine reduction when harms or burden outweigh benefit, while preventing withdrawal, disease recurrence and accidental loss of treatments that remain important to the person.
- Deprescribing is a planned, supervised dose reduction or stop when current harms, burden or limited benefit outweigh continued treatment.
- First clarify indication, duration, response, current disease control, time to benefit, adverse effects, dependence potential and the person's priorities.
- Do not stop corticosteroids, benzodiazepines, Z-drugs, opioids, gabapentinoids, antidepressants, antipsychotics, beta-blockers or antiseizure medicines abruptly without a condition-specific assessment.
- Prioritise urgent toxicity, duplicate treatment, no current indication, high-risk interactions and medicines that directly undermine cognition, mobility or goals.
- Make shared decisions; explain benefits, uncertainties, likely withdrawal symptoms, relapse features, taper flexibility and the option to pause or reverse.
- NICE NG215 recommends slow, stepwise reduction for dependence-forming medicines, with decrements becoming smaller as the dose becomes lower.
- A fixed universal taper is unsafe: drug half-life, duration, dose, previous attempts, comorbidity and patient response determine pace.
- Change a limited number at once when feasible and define who monitors which symptom, physiological measure and laboratory result.
- Document stop reason, taper, relapse criteria and whether a future restart is appropriate so transitions do not undo the decision.
- Optimisation includes adding or preserving beneficial therapy; deprescribing is not a one-way target to minimise the medicine count.
Key red flags
Abrupt systemic corticosteroid withdrawal with hypotension, vomiting, hyponatraemia or hypoglycaemia requires emergency adrenal treatment.
Seizure after interruption of an antiseizure medicine or sedative requires immediate seizure management and medication reconciliation.
Severe agitation, hallucination, autonomic instability or confusion during benzodiazepine reduction may represent dangerous withdrawal.
Suicidal thinking, mania, psychosis or severe depressive relapse during psychotropic change needs urgent mental-health assessment.
Chest pain, decompensated heart failure, uncontrolled hypertension or tachyarrhythmia after cardiovascular withdrawal requires acute review.
A medicine stopped unintentionally during admission, supply failure or swallowing change should be treated as a transition safety incident.
Hypotension, hypoglycaemia, seizure, hallucinations or autonomic instability after abrupt withdrawal is time critical.
A transition, formulation problem or supply gap stops essential treatment without a clinical decision.
Investigation priorities
Determine why therapy exists and prior response.
Management branches
A medicine's current benefit-harm balance is uncertain or unfavourable.
- Confirm indication, exposure, treatment response, withdrawal risk, organ function and the person's goal.
- Agree whether to continue, reduce or trial-stop and write the expected benefit, taper, warning signs and review measure.
- Implement with correct formulations and communication, then continue, pause or reverse according to observed outcomes.