Deprescribing Frameworks: How to Safely Reduce Medications and Cut Side Effects
Dec, 15 2025
Every year, millions of older adults take more medications than they need. Some have been on the same pills for decades-antacids for heartburn, sleeping pills for occasional insomnia, cholesterol drugs after a single high reading. But what if those medications are doing more harm than good? That’s where deprescribing comes in. It’s not about stopping meds cold turkey. It’s a careful, step-by-step process to remove drugs that no longer help-or worse, hurt.
Why Deprescribing Matters Now More Than Ever
By age 65, the average person in the U.S. or Australia takes five or more medications. For many, that number climbs to 10 or more. This isn’t just common-it’s dangerous. Around 40% of older adults globally are on at least one potentially inappropriate medication, according to the World Health Organization. And it’s not just side effects like dizziness or confusion. These drugs increase the risk of falls, kidney damage, memory loss, and hospital stays. In fact, one in three hospital admissions for people over 65 is linked to medication problems. Deprescribing flips the script. Instead of adding more pills when new symptoms appear, it asks: Is this drug still helping? It’s not about cutting corners. It’s about cutting clutter. A 2023 study in JAMA Internal Medicine showed that when older adults had five or more medications reduced under a structured plan, their risk of side effects dropped-without increasing hospital visits. That’s the opposite of what most people expect.What Deprescribing Actually Looks Like
Deprescribing isn’t a single rule. It’s a set of proven frameworks designed for real-world use. The most widely used ones focus on five high-risk drug classes: proton-pump inhibitors (PPIs), benzodiazepines, antipsychotics, blood sugar drugs, and opioids. Take PPIs, for example. These are the acid reducers like omeprazole, often prescribed for heartburn. But most people take them way longer than needed. Studies show that after eight weeks, many patients no longer need them. The deprescribing protocol? First, check if the original reason still exists. Then, slowly lower the dose over four to eight weeks. Watch for rebound heartburn. If symptoms return, reassess-not restart blindly. Benzodiazepines like lorazepam or zolpidem are another big one. These are sedatives used for anxiety or sleep. But they increase fall risk by up to 50% in seniors. The guideline says: evaluate sleep quality, check for cognitive decline, and taper by 25% every two weeks. Most patients can stop without major issues-especially when they’re supported by a pharmacist. The Shed-MEDS framework is one of the most validated. It stands for: Best Possible Medication History, Evaluate, Deprescribing Recommendations, Synthesis. In a clinical trial with 372 older adults, this method cut medication counts from 11.3 to 9.5 on average-and kept patients safe. No rise in emergencies. No spike in deaths. Just fewer pills, better function.Who Leads the Way in Deprescribing?
You might think doctors lead this process. But the real heroes are often pharmacists. A 2022 Canadian study found that when pharmacists were involved, deprescribing success rates jumped by 35-40%. Why? They spend time reviewing every pill, spotting overlaps, checking interactions, and talking to patients in ways doctors rarely can. In Canada, the Deprescribing Guidelines in the Elderly (DIGE) program has been rolled out nationwide since 2018. Pharmacists now have access to free, step-by-step algorithms from deprescribing.org. They use them in community pharmacies, nursing homes, and hospitals. In the U.S., adoption is slower. Only 28% of primary care practices have formal deprescribing protocols, compared to 63% in Canada. Nurse practitioners and geriatric specialists also play key roles. They’re trained to ask the right questions: What are your goals right now? Are you taking this for comfort, or for a disease that’s no longer active? For someone with advanced dementia, a blood pressure pill might not matter as much as staying calm and comfortable. Deprescribing isn’t about chasing numbers-it’s about aligning treatment with life goals.
The Hidden Barriers
Even with strong evidence, deprescribing is still rare. Why? Time. Most primary care visits last 7-10 minutes. That’s not enough to review 12 medications, explain why one might be stopped, and answer fears about withdrawal. Fear. Patients worry. “I’ve taken this for 15 years-what if I get worse?” Doctors worry too. “What if I’m sued if something goes wrong?” But research shows the opposite: stopping inappropriate meds reduces risk, not increases it. Technology. Most electronic health records don’t help. They flag drugs to add, not to remove. One U.S. hospital system changed that by making high-risk meds “opt-in only.” Doctors had to actively choose to prescribe them. Result? Prescriptions for benzodiazepines dropped by 41% in six months. And then there’s the lack of guidelines. Out of 3,569 recommendations in major clinical guidelines, only 248-just 7%-were about deprescribing. For drugs like antidepressants or blood thinners, there’s still no clear roadmap. Clinicians are left guessing.What Patients Really Say
A 2022 study interviewed 87 older adults who had medications reduced. Sixty-five percent said they felt lighter-fewer pills to manage, less confusion, fewer stomach issues. One woman stopped her daily antacid and realized her “heartburn” was actually from eating too late. She just needed to change her routine. But 22% felt anxious. “I was scared I’d wake up in pain,” said one man who stopped his muscle relaxant. His doctor had planned a slow taper, monitored him weekly, and offered a backup plan if symptoms returned. That reassurance made all the difference. The key? Communication. Patients need to understand why a drug is being stopped, how it will be done, and what to watch for. A simple handout or a 10-minute chat with a pharmacist can ease fears better than any prescription.
How to Start Deprescribing-Even If You’re Not a Doctor
You don’t need to be a specialist to begin. If you or a loved one is on five or more medications, here’s how to start:- Make a full list of everything taken-prescription, over-the-counter, vitamins, supplements. Don’t skip the antacids or sleep aids.
- Ask your doctor: “Is each of these still necessary? What was it for originally?”
- Look up the drug on deprescribing.org. They have free, plain-language guides for common medications.
- Ask if a pharmacist can review your meds. Many insurance plans now cover medication therapy management.
- If stopping a drug, ask for a taper plan-not a sudden stop. Some meds need weeks to come off safely.
- Track symptoms. Keep a simple log: “Day 5: Headache. Day 10: Sleeping better.” Share it at your next visit.
The Future Is Already Here
Change is coming fast. In June 2024, the American Medical Association officially urged doctors to routinely review all medications. Starting in 2026, Medicare will start paying doctors based on how well they reduce inappropriate prescribing. The FDA has poured $8.7 million into research to build AI tools that flag deprescribing opportunities in electronic records. By 2030, experts predict deprescribing checks will be as routine as checking blood pressure. The goal isn’t to eliminate all meds-it’s to make sure every pill earns its place. For older adults, that means fewer side effects, fewer falls, fewer hospital trips, and more freedom. It’s not about taking less. It’s about taking only what matters.Is deprescribing safe for older adults?
Yes, when done properly. Multiple studies, including a 2023 trial with 372 older adults, show that structured deprescribing reduces medication burden without increasing hospitalizations or deaths. The key is tapering slowly, monitoring symptoms, and involving a pharmacist or geriatric specialist. Stopping medications cold turkey can be dangerous-but following a clinical framework makes it safe.
What medications are most often targeted for deprescribing?
The top five classes are proton-pump inhibitors (PPIs) for heartburn, benzodiazepines and sleep aids like zolpidem, antipsychotics used for behavior in dementia, antihyperglycemics (blood sugar drugs) for people with limited life expectancy, and opioid painkillers for chronic non-cancer pain. These are the drugs most likely to cause harm in older adults without providing lasting benefit.
Can I stop my meds on my own?
No. Some medications, like blood pressure drugs, antidepressants, or seizure medications, can cause serious withdrawal symptoms if stopped suddenly. Even if you think a pill isn’t helping, always talk to your doctor or pharmacist first. They can help you create a safe tapering plan and monitor for side effects.
Does deprescribing mean I’ll have more pain or worse symptoms?
Not necessarily. Many older adults find their symptoms improve after stopping unnecessary meds. For example, stopping a sedative might improve balance and reduce falls. Stopping an acid reducer might reveal that heartburn was caused by eating habits, not stomach disease. The goal isn’t to worsen symptoms-it’s to remove drugs that aren’t helping and address the real cause.
How long does it take to see results after deprescribing?
It varies. For drugs like PPIs or sleep aids, people often feel better within 2-4 weeks of tapering. For blood pressure or diabetes meds, changes may take longer to notice. The most common benefit-fewer pills to manage-is immediate. Side effects like dizziness or confusion often improve within days. Monitoring for 4-8 weeks after stopping is recommended to ensure stability.
Are there tools or resources I can use at home?
Yes. Deprescribing.org offers free, downloadable algorithms for common medications in plain language. The American Geriatrics Society’s Beers Criteria lists 34 potentially inappropriate drugs for older adults. You can also ask your pharmacist for a medication review-many insurance plans cover this service. Keep a written list of all your meds and bring it to every appointment.
Why isn’t deprescribing more common if it’s so effective?
Three main reasons: time, fear, and system design. Doctors have short visits, patients fear stopping meds, and most electronic health records don’t support deprescribing-they only remind you to prescribe more. Training, pharmacist involvement, and updated tech are slowly changing this, but adoption is still uneven. Canada leads the world; the U.S. is catching up.
