The Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists
Recommendations from the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists on polypharmacy and harm reduction in prescribing policy. ASCEPT is the professional and independent Society in Australia and New Zealand with expertise in the use and toxicity of medicines and chemicals. Established in 1966, ASCEPT is affiliated with the International Union of Basic and Clinical Pharmacology (IUPHAR) and the International Union of Toxicology (IUTOX).
Stop medicines when no further benefit will be achieved or the potential harms outweigh the potential benefits for the individual patient.
Pharmacological treatments should cease when there are no further benefits to be achieved from the treatment, or when the potential harms from the treatment start to outweigh the potential benefits. This is particularly pertinent for elderly patients with a limited life expectancy where the treatments are unlikely to prevent disease events, and may in fact lead to adverse effects that reduce quality of life. These patients are at an increased risk of polypharmacy and increased drug events. For example, bisphosphonate treatment should not be administered to patients living in residential aged care facilities when these patients are already too frail to swallow drugs or have a life expectancy which is significantly less than 12 months.
- Maddison AR, Fisher J, Johnston G. Preventive medication use among persons with limited life expectancy. Prog Palliat Care 2011;19(1):15–21.
- Reeve E, Shakib S, Hendrix I, et al. The benefits and harms of deprescribing. Med J Aust 2014;201(7):386-9.
- Scott IA, Anderson K, Freeman CR, Stowasser DA. First do no harm: a real need to deprescribe in older patients. Med J Aust 2014; 201(7):390-2.
A working party of members of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) was established to propose an initial list of recommendations. ASCEPT’s membership was then invited to participate in an online survey to comment on the appropriateness of the proposed recommendations and suggest additional items for consideration.
Based on the survey responses, six recommendations were shortlisted. Following an evidence review the top 5 list items were selected. The final list was signed off by the ASCEPT President in April 2016.
- 1 Recognise and stop the prescribing cascade.
- 2 Reduce the use of medicines when there is a safer or more effective non-pharmacological management strategy.
- 3 Avoid using a higher or lower dose than is necessary for the patient to optimise the ‘benefit-to-risk’ ratio and achieve the patient’s therapeutic goals.
- 4 Stop medicines when no further benefit will be achieved or the potential harms outweigh the potential benefits for the individual patient.
- 5 Reduce use of multiple concurrent therapeutics (hyper-polypharmacy).