The Deprescribing Guidelines for the Elderly project, funded by the Government of Ontario and co-led by Dr. Barbara Farrell and Dr. James Conklin, has developed three evidence-based guidelines to support clinicians in safely reducing or stopping medication in three specific drug classes — proton pump inhibitors, benzodiazepine receptor agonists, and antipsychotics.
The third of the three guidelines, for deprescribing antipsychotics, has been developed collaboratively by a team of pharmacists, family physicians, specialists and medical researchers.
What are antipsychotics?
Antipsychotics are a class of drugs sometimes used for behavioural and psychological symptoms of dementia and insomnia. They are primarily used to treat psychiatric disorders such as bipolar disorder and schizophrenia, among other disorders.
Antipsychotics appear to work by modulating dopamine and serotonin neurotransmission in the brain. This results in a calming, relaxing effect, but can also produce sedation and affect balance.
Deprescribing algorithm for antipsychotics
To support clinicians in employing the recommendations outlined in the guideline, the team developed and piloted a two-page deprescribing algorithm.
This algorithm helps clinicians decide when and how to reduce antipsychotics safely and how to monitor effect.
As life changes, medications that were once right for a person may no longer be the best choice for them.
The evidence-based guidelines and algorithms developed through this project will help clinicians and their patients reduce unnecessary medications or those that may be causing harm to improve physical and mental well-being and overall quality of life.
Patients should always discuss plans to reduce or stop medications with their prescriber and pharmacist.
Other deprescribing guidelines and algorithms
The team has also developed deprescribing algorithms for —
- Proton pump inhibitors, a class of drugs that reduce acid production in the stomach, that are commonly used to treat heartburn, among other conditions.
Learn more about the proton pump inhibitor deprescribing algorithm
- Benzodiazepine receptor agonists, a class of drugs also called hypnotics or sedatives, that are commonly prescribed for insomnia, among other conditions.
Learn more about the benzodiazepine deprescribing algorithm
A new network to support deprescribing efforts
To continue this important work, Drs. Barbara Farrell and Cara Tannenbaum recently joined forces with a number of other interested colleagues to establish CaDeN — the Canadian Deprescribing Network — through a CIHR Partnerships for Health System Improvement grant to catalyze action and promote deprescribing across Canada.
Learn more about the Canadian Deprescribing Network
Document to download
Antipsychotic deprescribing algorithm
The views expressed in the antipsychotic deprescribing algorithm do not necessarily reflect those of the Government of Ontario.
User agreement and citation recommendation
Please use the algorithm freely, with credit to the authors. The algorithm is not for commercial use; do not modify or translate without permission. Contact email@example.com for more information.
Bjerre LM, Farrell B, Hogel M, Lemay G, McCarthy L, Rojas-Fernandez C, Sinha S, Thompson W. Welch V, Wiens A. (2016). Deprescribing antipsychotics for behavioural and psychological symptoms of dementia (BPSD) and insomnia: an evidence-based clinical practice guideline.
Translation to other languages
The Deprescribing team encourages clinicians and researchers from around the world to translate our algorithms into other languages. If you want to translate our algorithms into another language, we ask that you agree to the following:
1. Follow the Algorithm Translation Steps described below.
2. Use a forward and backward translation technique (described below in step 3).
3. Ask your translators for their certificate of translation so you can verify their qualifications. Show us these materials so we can also verify the qualifications of your translators.
4. Allow us to review and provide comments on your backward translation, and make the necessary revisions based on our comments.
5. Include, as part of your translated algorithm, the date and a brief description of the process that you used to translate our materials.
6. Provide us with copies of your final translation that you intend to disseminate and use.
Algorithm Translation Steps
1. Contact us and let us know that you would like to translate the algorithm. You can do this by e-mailing firstname.lastname@example.org.
2. We will respond to your request usually in less than seven days.
3. If you have not already done so, identify two professional translators. One will do the forward translation, and the other will do the backward translation. Note: The translator who is doing the backward translation should not be shown our original English language materials.
4. Have one translator conduct the forward translation.
5. Have the second translator do the backward translation into English.
6. Send the backward translation to us so we can verify its quality. We will provide our comments and revisions.
7. Make the necessary revisions.
8. Provide us with copies of your final materials.
9. Begin to use your translated algorithms.
Deprescribing team journal publications
- Thompson W, Quay TA, Rojas-Fernandez C, Farrell B, Bjerre LM. Atypical antipsychotics for insomnia: a systematic review. Sleep Med, 2016;22:13–7.
- Farrell B, Pottie K, Rojas-Fernandez CH, Bjerre LM, Thompson W, Welch V. Methodology for developing deprescribing guidelines: Using evidence and GRADE to guide recommendations for deprescribing. PLoS One, 2016;11(8):e0161248. doi:10.1371/journal.pone.016124.
- Thompson W, Hogel M, Li Y, Thavorn K, O’Donnell D, McCarthy L, Dolovich L Black C, Farrell B. Effect of a proton pump inhibitor deprescribing guideline on drug usage and costs in long-term care. JAMDA, 2016, in press, doi.org/10.1016/j.jamda.2016.04.020.
- Boghossian TA, Rashid FJ, Welch V, Rojas-Fernandez C, Moayyedi P, Pottie K, Walsh K, Pizzola L, Thompson W, Farrell B. Deprescribing versus continuation of chronic proton pump inhibitor use in adults (protocol). Cochrane Database Syst Rev, 2015; Issue 11, article number CD011969.
- Conklin J, Farrell B, Ward N, McCarthy L, Irving H, Raman-Wilms L. Developmental evaluation as a strategy to enhance the uptake and use of deprescribing guidelines: protocol for a multiple case study. Implement Sci, 2015 Jun 18;10(1):91. doi: 10.1186/s13012-015-0279-0.
- Farrell B, Tsang C, Raman-Wilms L, Irving H, Conklin J, Pottie K. What are priorities for deprescribing for elderly patients? Capturing the voice of practitioners: A modified Delphi process. PLOS One, 2015; 10(4):e0122246.
- Thompson W, Farrell B. Deprescribing: What is it and what does the evidence tell us? Canadian Journal of Hospital Pharmacy, 2013; 66(3):201–2.