Table 1:

Examples of medications to possibly deprescribe at certain steps of medication review3,4^*

Reason to stop medication or decrease dose	Examples	Comment
Noncompliance without negative health effect	Antihypertensive Oral diabetic medication	Identified through careful visual review of medications brought in by the patient and discussion about his or her understanding of and attitudes toward the medications and pill-taking habits
Taken incorrectly without negative health effect (or without benefit)	Puffers: some delivery systems are easier to use by older patients	In some circumstances, use can be corrected by showing patient how to use an aerochamber
Not indicated or relative contraindication	Statin for primary prevention	No evidence for benefit in older patients
	Docusate	Insufficient evidence for benefit to recommend or not recommend
	Calcium-channel blocker in patient with systolic heart failure
No longer indicated	Bisphosphonate after 5 yr	No evidence of effectiveness after 5 yr of continuous treatment
	Clopidogrel: as per guideline after cute coronary syndrome	Treatment often extends beyond guideline recommendations
	Benzodiazepine NSAID PPI	Intended for short-term use but susceptible to “prescribing inertia” (tendency to automatically renew a medication even when the original indication is no longer present)
	Cholinesterase inhibitor (e.g., in patient with very limited prognosis)	Patient moves to terminal phase of illness
Inappropriate choice for geriatric patient	Digoxin > 125 μg/d34	Risk of toxicity with age-related decline in renal function
Inappropriate choice for geriatric patient	Amitriptyline34	Risk of falls and fractures
No longer aligns with goals of care or life expectancy	Statin in patient with limited life expectancy (< 5 yr) Bisphosphonate in patient with limited life expectancy (< 2 yr)
No longer aligns with goals of care or life expectancy	Coumadin: decision requires discussion with patient about risk–benefit balance	No current evidence to guide at what point age-related risk outweighs benefit; frailty and expected life expectancy may be more relevant factors

Note: NSAID = nonsteroidal anti-inflammatory drug, PPI = proton pump inhibitor, START = screening tool to alert doctors to the right treatment.
↵* START criteria may identify medications that a patient should be taking but is not.