Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Acute harm after medicine change
Abrupt corticosteroid, benzodiazepine, antiseizure, opioid, clonidine or insulin change can cause adrenal crisis, seizure, withdrawal, ketoacidosis or haemodynamic deterioration. Deprescribing does not justify ignoring an acute iatrogenic emergency.
Action: Use ABCDE assessment, check glucose and ketones when relevant, obtain an exact timeline and restore essential treatment by a feasible route while seeking endocrine, diabetes, neurology, pharmacy or palliative advice. Treat seizure, adrenal crisis, hypoglycaemia or ketoacidosis under the emergency pathway and revise the deprescribing record.
Synopsis
Reconcile every medicine against current goals, prognosis, time to benefit, immediate harm, withdrawal risk and route, then stop, taper, continue or replace treatment through shared decisions and active follow-up.
Deprescribing is a planned clinical intervention, not simply deleting prescriptions: identify indication, current benefit, time to benefit, burden, interaction, route and withdrawal risk for every medicine.
First-line reconciliation includes prescription chart, repeats, specialist medicines, injections, patches, inhalers, over-the-counter products and what the person actually takes.
Prioritise medicines causing immediate harm or burden, those without a current indication and preventive treatment whose benefit lies beyond the person's likely timeframe.
Key red flags
Systemic corticosteroid used for weeks or at suppressive doses must not be stopped abruptly without adrenal-risk assessment.
Dangerous withdrawal state
New seizure, severe hypotension, vomiting, hypoglycaemia, hyperglycaemia or autonomic distress after cessation requires immediate medicine and metabolic review.
Investigation priorities
01
First-line complete medicine reconciliationFirst stepFirst line
Compare all clinical records with containers and patient or carer report, including non-oral, specialist and non-prescribed products.
Management branches
Structured reviewClassify every medicine by present value
Prognosis, function, kidney or liver status, goals or swallowing changes, or a care transition occurs.
Reconcile the actual regimen and ask the person what helps, harms and creates burden; involve a pharmacist for complex interactions and formulations.
Map indication, time to benefit, immediate harm, withdrawal risk and feasible route and identify duplicates and prescribing cascades.
Key medicines
Basal insulin in type 1 diabetesContinue a once-daily basal insulin regimen even when the person is not eating; any dose reduction must be individualised from recent glucose, intake, frailty and prior requirement with diabetes or palliative specialist advice.
Systemic corticosteroid continuation or taperContinue the current effective daily corticosteroid or convert to an equivalent feasible route when it prevents symptoms; if benefit has ended, taper according to dose, duration, indication and adrenal risk rather than stopping abruptly.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.