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).
Reduce use of multiple concurrent therapeutics (hyper-polypharmacy).
Polypharmacy — variously defined as more than five or up to 10 or more medications taken regularly — is common among elderly patients. However, patients who are prescribed with multiple, concurrent therapeutics may be on as many as 15 to 20 drugs at time. Research has confirmed a significant association between polypharmacy and adverse outcome among older people living in the community because the toxicities and side effects associated with prescribed drugs are accrued over many years. Polypharmacy in older people is associated with decreased physical and social functioning; increased risk of falls, delirium and other geriatric syndromes; hospital admissions; and, deaths.
- Davies EC, Green CF, Taylor S, et al. Adverse drug reactions in hospital in-patients: A prospective analysis of 3695 patient-episodes. PLoS ONE 4(2):e4439.
- Hubbard RE, Peel NM, Scott IA, et al. Polypharmacy among inpatients aged 70 years or older in Australia. Med J Aust 2015;202(7):373-7.
- 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).