Deprescribing Frameworks: How to Safely Reduce Medications and Reduce Side Effects

Every year, millions of older adults take medications that no longer help them-and may be hurting them. It’s not laziness or neglect. It’s often just how medicine works: a drug gets added for one condition, then another, then another. Over time, the list grows. And so do the side effects: dizziness, confusion, falls, stomach bleeds, fatigue. Many patients don’t even realize their symptoms are drug-related. That’s where deprescribing comes in-not just stopping pills, but doing it safely, systematically, and with purpose.

What Deprescribing Really Means

According to the World Health Organization, about 40% of older adults worldwide are taking five or more medications at once-a situation called polypharmacy. And it’s dangerous. A 2023 study from the American Geriatrics Society found that inappropriate polypharmacy contributes to 30% of hospital admissions in people over 65. Many of those admissions could have been avoided if those medications had been reviewed and, when needed, safely reduced.

Deprescribing frameworks were developed to bring structure to this process. Before 2010, doctors often didn’t know how to stop medications safely. Now, there are clear protocols for the most common high-risk drugs: proton-pump inhibitors (PPIs), benzodiazepines, antipsychotics, blood sugar medications, and opioids. Each framework follows the same basic steps: identify the drug, check if it’s still needed, taper it slowly, and monitor for changes.

The Shed-MEDS Framework: A Proven Method

1. Best Possible Medication History-get a complete, accurate list of everything the patient is taking, including over-the-counter drugs and supplements.
2. Evaluate-use guidelines like STOPP/START or the Beers Criteria to flag drugs that may be inappropriate for older adults.
3. Deprescribing Recommendations-prioritize which drugs to reduce first based on risk, benefit, and patient goals.
4. Synthesis-create a clear plan with the patient and care team, including tapering schedules and warning signs to watch for.

A 2023 JAMA Internal Medicine trial tested Shed-MEDS in 372 older adults in post-acute care. The results were striking. Patients in the deprescribing group went from an average of 11.3 medications down to 9.5 at discharge-and still had 1.6 fewer meds at 90 days. The best part? There was no increase in hospital visits or adverse events. The control group, which got usual care, didn’t see any change in their medication count.

Which Medications Are Most Often Overused?

• Proton-pump inhibitors (PPIs)-like omeprazole or pantoprazole. Many people take them for heartburn, but most don’t need them long-term. Stopping them safely can reduce risks of kidney damage, bone fractures, and infections.
• Benzodiazepines and sleep aids-drugs like lorazepam, diazepam, or zolpidem. These increase fall risk and confusion in older adults. Tapering them slowly over 4-8 weeks can improve alertness and balance.
• Antipsychotics-often prescribed for dementia-related agitation, even though they’re not approved for that use. These drugs can cause tremors, stiffness, and even sudden death. Deprescribing them often leads to better behavior, not worse.
• Antihyperglycemics-medications like glyburide or insulin for diabetes. Tight blood sugar control isn’t always better in older adults. Reducing these can prevent dangerous low blood sugar episodes.
• Opioid painkillers-long-term use increases risk of addiction, constipation, and respiratory issues. For chronic non-cancer pain, non-drug options and lower doses often work better.

Each of these has a published deprescribing algorithm on deprescribing.org. These aren’t vague suggestions-they’re step-by-step guides with specific tapering schedules and monitoring recommendations.

Why It’s Hard to Do in Practice

Pharmacists are the secret weapon. Studies show deprescribing success rates jump 35-40% when pharmacists are involved. They have the time to sit with patients, explain why a drug might be stopped, and manage the tapering process. But most clinics don’t have pharmacists on staff-or don’t let them lead the process.

Electronic health records (EHRs) aren’t helping much either. Only 32% of clinicians say their EHR system supports deprescribing. Most systems are built to remind doctors to add medications, not to question if they’re still needed. Some forward-thinking health systems have flipped the script: instead of letting doctors prescribe a risky drug easily, they make them actively choose to override a warning. That small design change has reduced inappropriate prescribing by up to 40% in pilot programs.

The Human Side: Patient Fear and Trust

A 2022 study found that 65% of older adults felt relieved after reducing their meds. But 22% were anxious-even terrified. One woman stopped her daily statin after her pharmacist walked her through the evidence: her cholesterol was normal, her risk of heart disease was low, and she’d been experiencing muscle pain for years. She cried when she realized the pain wasn’t just aging-it was the drug.

But others worry about rebound symptoms. What if the heartburn comes back? What if they can’t sleep? That’s why tapering matters. You don’t just flip a switch. You reduce slowly, watch closely, and give patients control. A good deprescribing plan includes a written plan, a contact number for questions, and a follow-up visit within 2-4 weeks.

What’s Changing in 2025?

Medicare is catching up too. Starting in 2026, doctors will be scored on how often they reduce inappropriate medications. That means clinics will need systems, training, and time to do this right.

Researchers are also working on AI tools that scan EHRs and flag patients who might benefit from deprescribing. These tools look at age, diagnoses, drug combinations, lab results, and even pharmacy refill patterns to suggest candidates. One pilot at a large hospital system flagged 1,200 patients in six months-87% of whom were on at least one high-risk medication.

By 2030, experts predict deprescribing checks will be as routine as checking blood pressure during annual wellness visits. The data is clear: reducing unnecessary meds saves money, prevents hospitalizations, and improves daily life.

What Patients Can Do Today

1. Make a complete list of everything you take-prescriptions, vitamins, herbal supplements, OTC painkillers. Include doses and why you take them.
2. Ask your doctor: “Is this still necessary?” and “What would happen if I stopped it?”
3. Request a medication review with a pharmacist. Many insurance plans cover this service.
4. Don’t stop anything cold turkey. Ask for a tapering plan if you’re thinking about quitting.
5. Track how you feel after reducing a drug. Did your energy improve? Did the dizziness go away? Write it down.

Deprescribing isn’t about giving up treatment. It’s about getting back to what matters: feeling well, moving without pain, sleeping without pills, and living without the burden of too many medications.

Final Thoughts

The future of medicine isn’t just adding more drugs. It’s knowing when to let go.