gms | German Medical Science

25. Jahrestagung des Netzwerks Evidenzbasierte Medizin e. V.

Netzwerk Evidenzbasierte Medizin e. V. (EbM-Netzwerk)

13. - 15.03.2024, Berlin

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Deprescribing of psychotropic, sedative, and anticholinergic medications: synthesizing the evidence for a digital tapering support tool

Meeting Abstract

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  • Kerstin Bernartz - Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Deutschland
  • Svenja Claaßen - Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Deutschland
  • Prashamsa Chapidi - Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Deutschland
  • Kiran Chapidi - Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Deutschland
  • Stephanie Picker-Huchzermeyer - Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Deutschland
  • Helga Nolte - Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Deutschland
  • Tobias Dreischulte - LMU Klinikum, Institute of General Medicine, München, Deutschland
  • Annette Härdtlein - LMU Klinikum, Institute of General Medicine, München, Deutschland
  • Vita Brisnik - LMU Klinikum, Institute of General Medicine, München, Deutschland
  • 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, Deutschland
  • 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, Deutschland
  • 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, Deutschland
  • Hanna Seidling - Heidelberg University Hospital, Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Deutschland; University of Heidelberg, Clinical Pharmacy Cooperation Unit, Heidelberg, Deutschland
  • Sophia Klasing - Heidelberg University Hospital, Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Deutschland; University of Heidelberg, Clinical Pharmacy Cooperation Unit, Heidelberg, Deutschland
  • Mark Horowitz - North East London NHS Foundation Trust (NELFT), London, Großbritannien
  • Christiane Muth - Bielefeld University, AG General and Family Medicine, Faculty of Medicine OWL, Bielefeld, Deutschland

Evidenzbasierte Politik und Gesundheitsversorgung – erreichbares Ziel oder Illusion?. 25. Jahrestagung des Netzwerks Evidenzbasierte Medizin. Berlin, 13.-15.03.2024. Düsseldorf: German Medical Science GMS Publishing House; 2024. Doc24ebmPS6-1-08

doi: 10.3205/24ebm109, urn:nbn:de:0183-24ebm1093

Veröffentlicht: 12. März 2024

© 2024 Bernartz et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Background/research question: Deprescribing (dose reduction or stopping) of psychotropic drugs in patients with polypharmacy can be challenging due to withdrawal symptoms that are difficult to tolerate. Choosing optimal tapering regimens can assist physicians and patients in successfully discontinuing inappropriately prescribed psychotropic medications and reducing drug burden. Our goal was to synthesize evidence on tapering schemes and withdrawal symptoms for the psychotropic drugs most commonly prescribed by family physicians in Germany to inform the development of a digital support tool.

Methods: In response to the urgent need to support the decision-making of family physicians participating in the cluster-randomized controlled trial, PARTNER (Innovation Fund, Fkz: 01VSF21038), a rapid review was performed. We conducted a systematic search in 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 independently performed study selection and data extraction. The data were narratively synthesized and categorized by six medication groups.

Results: Of 1,828 publications identified by our search strategy, 53 studies on tapering regimens and 67 studies describing common withdrawal symptoms were included in the analysis. The choice of tapering schemes depends on the treatment indications, medication dosage, treatment duration, and patient preferences. Hyperbolic tapering (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. The feasibility of the tool is currently being tested in the PARTNER trials.

Conclusion: Our data informed the development of a digital practice support tool based on the application of evidence-based recommendations for tapering psychotropic medications. Hyperbolic tapering is a novel approach that may help reduce withdrawal symptoms and increase the likelihood of successful deprescribing.

Competing interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.