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

Every year, millions of older adults take more medications than they need. Some have been on the same pills for decades-antacids for occasional heartburn, sleeping pills for restless nights, or antipsychotics for mild agitation. But what if those medications are doing more harm than good? That’s where deprescribing comes in. It’s not about stopping meds cold turkey. It’s a careful, step-by-step process to remove drugs that no longer serve you, especially when the risks outweigh the benefits.

What Exactly Is Deprescribing?

Deprescribing is the planned, gradual reduction or discontinuation of medications that may no longer be necessary-or that might be causing more harm than help. It’s not a one-size-fits-all approach. It’s personalized. You look at the patient’s age, health goals, life expectancy, and what matters most to them. Is it living independently? Avoiding falls? Sleeping through the night? Reducing confusion?

It’s especially important for older adults. Around 40% of people over 65 take five or more medications at once-a situation called polypharmacy. And that’s where things get risky. Studies show that inappropriate polypharmacy contributes to nearly 30% of hospital admissions in this age group. Many of those admissions are preventable.

The idea gained traction around 2010, led by researchers in Canada like Barbara Farrell and Cara Tannenbaum. Today, deprescribing.org is the go-to resource for evidence-based guidelines. And it’s not just a theory. Real-world trials show it works. One 2023 study with 372 older adults found that those who went through a structured deprescribing program ended up taking 1.6 to 1.8 fewer medications-without an increase in hospital visits or side effects.

Which Medications Are Most Often Targeted?

Not all drugs are equal when it comes to deprescribing. Some carry higher risks, especially for older adults. Five medication classes are the main focus of current guidelines:

• Proton-pump inhibitors (PPIs) - Often prescribed for heartburn, but many people stay on them years longer than needed. Long-term use can lead to nutrient deficiencies, bone fractures, and kidney issues.
• Benzodiazepines and sleep aids - Used for anxiety or insomnia, but they increase fall risk, confusion, and dependence. Tapering them slowly can improve alertness and balance.
• Antipsychotics - Sometimes given for behavioral symptoms in dementia, even though they’re not approved for that use. They raise the risk of stroke and sudden death in older adults with dementia.
• Antihyperglycemics - Blood sugar drugs like sulfonylureas can cause dangerous low blood sugar episodes in seniors, especially those with limited life expectancy.
• Opioid analgesics - Pain meds that can lead to addiction, constipation, dizziness, and breathing problems. Often overused for chronic, non-cancer pain.

Each of these has a clear, step-by-step deprescribing protocol. For example, the PPI guideline says: first, check if the original reason for taking it still exists. Then, try lowering the dose or switching to an as-needed schedule. Finally, monitor for rebound symptoms. Most people can stop PPIs safely over 4 to 8 weeks.

How Do You Actually Do It? The Shed-MEDS Framework

One of the most proven methods is called Shed-MEDS. It’s a simple four-step process used in hospitals and clinics across North America:

1. Best Possible Medication History - Get a complete list of everything the patient is taking, including over-the-counter pills, supplements, and creams. Many people forget to mention these.
2. Evaluate - Use tools like the STOPP/START criteria (updated in 2021) or the Beers Criteria (2023 edition) to flag potentially inappropriate drugs. Ask: Is this drug still helping? Is it causing side effects? Does the patient’s condition still justify it?
3. Deprescribing Recommendations - Decide which meds to stop or reduce. Prioritize high-risk drugs first. Always involve the patient. Don’t assume they want to stop everything.
4. Synthesis - Create a clear plan: which drug to stop, how fast, what to watch for, and when to follow up. Give the patient a written schedule.

A 2023 JAMA Internal Medicine trial showed this method reduced medication counts by 1.8 drugs at discharge from rehab centers-and that reduction held at 90 days. No increase in emergencies. No rise in deaths. Just fewer pills, better function.

Why Isn’t Everyone Doing This?

If deprescribing works so well, why isn’t it standard practice?

The biggest barrier? Time. Primary care doctors in the U.S. average just 7.2 minutes per patient visit. That’s not enough to review a list of 10+ medications, talk through risks and benefits, and build trust around stopping something the patient has taken for 15 years.

Another issue? Lack of support. Only 32% of clinicians feel their electronic health records help them identify drugs to deprescribe. Most systems are built to remind doctors to prescribe-never to stop.

And there’s fear. Both from doctors and patients. Doctors worry about being blamed if something goes wrong. Patients worry they’ll lose control or wake up feeling worse. A 2022 study found 22% of older adults felt anxious about stopping long-term meds-even when told it was safe.

The good news? Pharmacists are making a huge difference. When pharmacists lead the process, deprescribing success rates jump by 35-40%. They have the training, the time, and the tools. In Canada, where pharmacist-led deprescribing is embedded in the system, 63% of primary care practices have formal protocols. In the U.S., it’s only 28%.

What’s Changing in 2025?

Things are shifting fast. In June 2024, the American Medical Association issued its first official policy: physicians must routinely assess whether every medication is still appropriate. That’s huge.

Medicare is catching up too. Starting in 2026, Medicare Advantage plans will be scored on how well they reduce inappropriate prescribing. That means hospitals and clinics will be financially incentivized to deprescribe.

The National Institutes of Health is funding new research to create guidelines for 8 more drug classes-like antidepressants and blood thinners-that currently lack clear deprescribing pathways. AI tools are also being developed to scan electronic records and flag patients who might benefit from deprescribing.

By 2030, experts predict deprescribing checks will be as routine as checking blood pressure during annual wellness visits. The goal? A 40% drop in medication-related hospitalizations among older adults by then.

What Patients Should Know

If you or a loved one is on multiple medications, here’s what to do:

• Ask your doctor: “Is this medicine still helping? Could it be causing problems?”
• Bring a full list of everything you take-including vitamins, herbs, and OTC pills.
• Don’t stop anything on your own. Tapering matters. Stopping benzodiazepines or antidepressants too fast can cause seizures or rebound anxiety.
• Ask if a pharmacist can help review your meds. Many pharmacies offer free medication reviews.
• Track how you feel after a medication is reduced. Did your energy improve? Did the dizziness go away? Did you sleep better?

It’s not about cutting meds for the sake of cutting them. It’s about living better-with fewer side effects, fewer falls, less confusion, and more control over your own health.

Tools and Resources You Can Use

You don’t need to figure this out alone. These are free, evidence-based tools used by professionals:

• deprescribing.org - Offers downloadable algorithms for tapering PPIs, benzodiazepines, antipsychotics, and more.
• STOPP/START Criteria (v3, 2021) - A checklist that tells you which drugs to avoid and which to start in older adults.
• Beers Criteria (2023) - The gold standard list of potentially inappropriate medications for seniors.

Most of these are available as printable PDFs. Print them out. Bring them to your next appointment. Use them to start the conversation.

Final Thought: It’s Not Just Stopping-It’s Starting Over

Deprescribing isn’t the opposite of prescribing. It’s just as intentional. You don’t just take a pill off the list. You replace it with safety, clarity, and quality of life.

For many older adults, reducing medications means more energy, fewer trips to the bathroom at night, less dizziness when standing up, and the ability to enjoy meals with family without worrying about pill schedules.

It’s not about taking fewer pills. It’s about living more.