Overview
Safely deprescribing psychiatric medications is an important component of high-quality prescribing. The need for safe deprescribing has been highlighted by a Public Health England report, new NICE guidance, and a call from NHS England to scale up services. These initiatives have arisen in response to recognition of opportunities for optimising prescriptions as well as calls from patient groups for more help in safely stopping no longer needed medication.
The NICE guidelines currently recommends that antidepressants, benzodiazepines, z-drugs and opioids are regularly reviewed and, if no longer necessary, tapered in a manner proportional to their current dose (so that reductions get smaller and smaller in size as the total dose gets smaller). This approach to tapering reflects the pharmacological properties of psychiatric medications (small doses have large effects). This hyperbolic/proportionate approach to tapering presents a number of practical difficulties to the practising clinician in implementing this guidance in practice.
In this session we will outline the scientific rationale behind hyperbolic/proportionate tapering, explain how to implement this in clinical practice and point clinicians towards resources that outline the process in a step-by-step manner.
Objectives
- Understand the scientific rationale and existing evidence for hyperbolic tapering of psychiatric medications.
- Become familiar with existing guidance and information on hyperbolic tapering from NICE and RCPsych.
- Understand how to implement hyperbolic tapering in practice – including using liquid formulations of medication or off-licence options.
Speakers
Chair: Professor Robin Murray, King's College London, London
Professor David Taylor, King's College London, London
Dr Mark Horowitz, North East London NHS Foundation Trust , University College London (honorary), London
