“Deprescribing” In End of Life Patients: A Guide to Improve Clinical Practice

Abstract

Deprescribing consists on a systematic evaluation of the
potential risks and benefits of each drug for a given patient,
considering the clinical condition and vital prognosis. This
process must be part of every patient’s care plan but most
importantly in patients at the end of life, i.e., the last 12 months
of life, consisting in a matter of great pertinence in the scope
of Palliative Care. Drugs with a time to benefit that exceeds
the patient’s estimated life expectancy should be discontinued-mostly drugs given as primary prevention, like statins. The
maintenance of other pharmacological groups can be indicated, provided that the goals of care adjustment is guaranteed
(e.g.: antimicrobials, anticoagulants, proton pump inhibitors
and hypoglycemic agents). The deprescribing act intends to
avoid or reduce polypharmacy, thus minimizing potential iatrogenic events and the therapeutic burden which takes special
relevance at the end of life.