Deprescribing Tools for Clinicians
For Clinicians
Background
Polypharmacy is common in patients on hemodialysis, increasing the risk of adverse events, medication interaction, nonadherence, and mortality. Deprescribing is one way to minimize the risks of polypharmacy. Although deprescribing guidelines currently exist, they are not medication-specific nor developed specifically for the hemodialysis population.
In response, the STOPMed-HD research team has developed and validated a deprescribing toolkit specific to patients on hemodialysis. The toolkit targets nine medication classes commonly prescribed to this patient population.
Click here for more details on the project and content validation process
The Deprescribing Toolkit
Our validated deprescribing toolkit is an evidence-based and quality-focused initiative consisting of four key features:
1. Deprescribing Algorithms: Identifies patients taking a potentially inappropriate medication, provides appropriate tapering schedules, highlights key safety and effectiveness parameters, and provides triggers for decision making (flow-chart format)
2. Evidence Tables: Summaries of the available literature on the safety and efficacy of medications in HD patients, used to inform the creation of our deprescribing algorithms
3. Monitoring Forms: Printable forms can be inserted into the patient's record for ease of safety monitoring
4. Patient Information Tools: Supplementary educational material for hemodialysis patients consisting of a video and pamphlet; ensures the patient is appropriately involved in the deprescribing decision
Medications Supported
Alpha-1 Blockers
e.g. Alfuzosin (Xatral®); Doxazosin (Cardura-1®); Prazosin (Minipress®); Silodosin (Rapaflo®); Tamsulosin (Flomax CR®); Terazosin (Hytrin®)
Benzodiazepines / Z-Drugs
e.g. Alprazolam (Xanax®); Bromazepam (Lectopam®); Chlordiazepoxide (Librium®); Clobazam (Frisium®); Clonazepam (Rivotril®); Clorazepate (Tranxene®); Diazepam (Valium®); Flurazepam; Lorazepam (Ativan®); Midazolam (Versed®); Nitrazepam; Oxazepam (Serax®); Temazepam (Restoril®); Triazolam (Halcion®)
Gabapentinoids
e.g. Gabapentin (Neurontin® or Auro-Gabapentin®); Pregabalin (Lyrica®)
Loop Diuretics
e.g. Bumetanide (Burinex®); Ethacrynic acid (Edecrin®); Furosemide (Lasix®)
Prokinetic Agents
e.g. Domperidone (Motilium®); Linaclotide (Constella®); Metoclopramide (Metonia®, Reglan®); Prucalopride (Resotran®)
Proton Pump Inhibitors
e.g. Dexlansoprazole (Dexilant®); Esomeprazole (Nexium®); Lansoprazole (Prevacid®); Omeprazole (Losec®, Olex®); Pantoprazole magnesium (Tecta®); Pantoprazole sodium (Pantoloc®); Rabeprazole (Pariet®)
Statins
e.g. Atorvastatin (Lipitor®); Fluvastatin (Lescol®); Lovastatin (Mevacor®); Pravastatin (Pravachol®); Rosuvastatin (Crestor®); Simvastatin (Zocor®)