De-prescribing Medications

Clinical Judgment, Tapering Strategy, and Supervision in Action

As emerging clinicians, one of the most nuanced skills you'll develop is knowing when and how to safely reduce or discontinue a medication. De-prescribing isn’t simply about stopping a drug—it’s a structured, patient-centered decision rooted in evidence, experience, and supervision.

Why It Matters
De-prescribing is a clinical intervention. It's a deliberate and proactive process—not a reaction to nonadherence or symptom resolution. You’ll need to evaluate:

• Whether the original indication still applies

• Risk of long-term side effects or interactions

• Patient capacity to engage in alternative treatment plans (therapy, lifestyle changes)

• Polypharmacy in medically complex or geriatric populations

• Functional outcomes vs. symptom reduction

  
  

What to Consider as a Trainee
As a new clinician, ask yourself:

• Do I know the full indication and timeline of this med?

• Am I monitoring for withdrawal symptoms or symptom recurrence?

• Have I educated the patient on what to expect and created a backup plan?

• Did I review this case with a supervisor or senior colleague?

Remember: de-prescribing often requires as much, if not more, supervision than initiation.

Key Principles for Safe De-prescribing

• Start low, go slow… and stop slow.

• Use tapering schedules appropriate to half-life and receptor activity.

• Always document rationale, plan, and patient agreement.

• Monitor function, not just symptoms. Sometimes mild symptoms are tolerable if functioning improves.

• Involve caregivers when possible, especially with cognitively impaired or vulnerable patients.

  
  

Supervision as a Safety Net

You're not alone. De-prescribing decisions benefit from:

• Peer and supervisor input

• Chart reviews with senior staff

• Case discussions in supervision or didactics

Knowing when not to de-prescribe is just as important as knowing when to move forward.

Takeaway

De-prescribing is not a failure of treatment—it’s an evolution of care. Your ability to manage medications responsibly will define your maturity as a clinician. When in doubt, ask. And remember: less is sometimes more.