Article
Synthesizing evidence-based recommendations for tapering psychotropic, sedative, and anticholinergic medications: A rapid review
Zusammenfassung evidenzbasierter Empfehlungen zum Absetzen von Psychopharmaka, Sedativa und Anticholinergika: Ein Rapid Review
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Authors
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Kerstin Bernartz
- Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Germany
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Svenja Claaßen
- Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Germany
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Kiran Chapidi
- Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Germany
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Prashamsa Chapidi
- Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Germany
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Stephanie Picker-Huchzermeyer
- Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Germany
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Helga Nolte
- Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Germany
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Tobias Dreischulte
- LMU Klinikum, Institute of General Medicine, München, Germany
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Annette Härdtlein
- LMU Klinikum, Institute of General Medicine, München, Germany
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Vita Brisnik
- LMU Klinikum, Institute of General Medicine, München, Germany
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Achim Mortsiefer
- University of Witten/Herdecke, Faculty of Health, Institute of General Medicine and Ambulatory Health Care (IAMAG), Chair of General Medicine II and Patient Orientation in Primary Care, Witten, Germany
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Sophie Peter
- University of Witten/Herdecke, Faculty of Health, Institute of General Medicine and Ambulatory Health Care (IAMAG), Chair of General Medicine II and Patient Orientation in Primary Care, Witten, Germany
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Michaela Maas
- University of Witten/Herdecke, Faculty of Health, Institute of General Medicine and Ambulatory Health Care (IAMAG), Chair of General Medicine II and Patient Orientation in Primary Care, Witten, Germany
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Hanna Seidling
- Heidelberg University Hospital, Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany
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Sophia Klasing
- Heidelberg University Hospital, Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany
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Mark Horowitz
- North East London NHS Foundation Trust (NELFT), London, London, United Kingdom
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Christiane Muth
- Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Germany
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Svetlana Puzhko
- Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Germany
| Published: | November 7, 2023 |
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Outline
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Background: Polypharmacy in elderly patients increases the risk of serious adverse effects and geriatric syndromes such as falls, cognitive impairment, delirium, etc. Deprescribing psychotropic drugs can be especially challenging due to withdrawal symptoms that lower patients’ motivation for deprescribing. Choosing optimal tapering regimens can assist physicians and patients in successfully discontinuing inappropriately prescribed psychotropic medications, reducing drug burden, and improving quality of life. Our project’s goal was to synthesize evidence on tapering schemes and withdrawal symptoms for the sedative and anticholinergic psychotropic drugs most commonly prescribed by family physicians in Germany.
Materials and methods: A rapid review was conducted in response to the urgent need to support the decision-making of family physicians participating in the multisite cluster-randomized controlled trials on deprescribing inadequately prescribed psychotropic medications, PARTNER (Innovation Fund, Fkz: 01VSF21038). We systematically searched Medline (via PubMed) and Google Scholar for evidence-based guidelines and recommendations on tapering the most commonly prescribed sedative and anticholinergic psychotropic drugs in Germany using keywords (e.g., taper, withdrawal, antidepressant*) and MeSH terms (e.g., drug tapering, substance withdrawal syndrome, antidepressive agents). Two researchers performed study selection and data extraction. The data were narratively synthesized by medication groups.
Results: Our search strategy identified a total of 1,828 guidelines and recommendations. Fifty-three publications on tapering regimens for the target medication groups and 67 describing common withdrawal symptoms met the inclusion criteria and were included in the analysis. Depending on the treatment indications, treatment duration, total daily dose, tolerability of withdrawal symptoms, and patient preferences, different linear and hyperbolic tapering schemes are recommended. Hyperbolic tapering of sedative and anticholinergic psychotropic drugs (a hyperbolic reduction in daily doses, with the goal of achieving a linear reduction in receptor occupancy) is considered a more physiological way to reduce medication dosage and mitigate the risk of withdrawal symptoms compared to linear dose reduction. Based on the synthesized evidence, a digital tapering support tool was developed to assist physicians with their decision-making regarding deprescribing. The tool includes 1) a synthesized summary of guidelines and recommendations on tapering by medication groups, 2) tapering schemes by medication groups and active ingredients depending on the current daily dose, and 3) a summary of possible withdrawal symptoms by the medication group. The feasibility of the tool is currently being tested in the PARTNER trials.
Conclusion: Discontinuing inadequately prescribed psychotropic medications in elderly patients with multimorbidity and polypharmacy is necessary, as side effects may outweigh the benefits of these medications. Hyperbolic tapering is a novel approach that may help reduce withdrawal symptoms and increase the chances of successful deprescribing. Evidence-based tapering guides and tools can support physicians and patients in their shared decision-making for an individually tolerable tapering process and ensure successful deprescribing.
