Knowing how to stop: ceasing prescribing when the medicine is no longer required.

Abstract

Stopping prescriptions for medicines that patients no longer need is an important part of good prescribing practice. Yet, unlike the volumes of scientific evidence on starting medications, research to guide best practice prescribing cessation is rare. This would not be a concern if we could be confident that prescribing is routinely ceased when this is appropriate. There are reasons to believe that this is not the case. The concept of prescribing inertia provides a framework for understanding why prescribing might continue when it should not. Classic examples of short-term prescribing that should suffice include use of benzodiazepines, nonsteroidal anti-inflammatory drugs (NSAIDs, including cyclooxygenase [COX]-2 inhibitors), clopidogrel after stent insertion, and many instances of use of gastrointestinal medications such as proton pump inhibitors (PPIs). Pharmacoepidemiological evidence, growing problems with polypharmacy, and analyses of prescriber behavior also suggest that prescribing may often not stop when it should. There is little evidence to indicate whether prescribers perceive failure to cease prescribing to be a problem for prescribing practice. However, relevant indirect evidence suggests that the lack of research on how best to stop prescribing may be contributing to this problem.