Table 1 Strategies for addressing problems with medication regimens

General approaches

• For the patient who is non-adherent because of issues of feasibility, it is advisable to reduce the total burden of medication in addition to providing increased support for taking medications, even including medications with known benefit.

• It is reasonable to undertake dose reduction or discontinuation of medications associated with both benefits and side effects if the patient views the side effects as more important than the benefits.

• It is reasonable to discontinue medications prescribed for primary/secondary disease prevention if the patient views the reduction of risk as insufficiently large.

• Clinicians and patients should have a discussion to prioritize patients’ goals for their medications and decide on a regimen that reflects this priority.

• Patients with polypharmacy even after steps are taken to discontinue medications should be informed of the risks associated with polypharmacy.

Specific approaches

• Medications on the Beers and STOPP lists should be considered for discontinuation, unless there is a compelling reason not to do so.

• Medications without an indication should be discontinued.

• A trial of dose reduction/discontinuation of medications with patient self-report of adverse effect should be undertaken, with re-evaluation to assess for improvement and possible rechallenge.

• Dose reduction/discontinuation of medications should be undertaken in patients with excessively tight control of DM.

• Dose reduction/discontinuation of medications should be undertaken in patients with excessively tight control of HTN.