Reviewing Long-Term Medication: What You Really Still Need

Many medicines are started for a good reason — and then never questioned again. Over the years new ones are added, old ones stay, and at some point nobody knows exactly what the little white tablet in the evening is actually for. Deprescribing is the term for the planned, medically supervised reduction or stopping of medicines whose benefit no longer outweighs the possible harm. This guide shows you how to set such a review in motion, which medicines often come under scrutiny — and why one rule always applies: never stop anything on your own.

1. What deprescribing means — and what it does not

Deprescribing is not leaving things out based on gut feeling, nor is it a cost-cutting measure. It means a structured process: your entire medication is checked regularly to see whether each medicine is still needed, whether the dose is right and whether there is a safer alternative. The German S3 guideline on multimedication issued by the professional society for general practice describes exactly this process as a fixed part of the care of people who take several long-term medicines.^¹

A review can end with many different outcomes:

• Stopping a medicine that is no longer necessary
• Reducing the dose, for example because your kidney function or weight has changed
• Switching to an active substance with a more favourable side-effect profile
• Keeping it — with the reassuring certainty that everything is justified
• and sometimes also adding something, if a useful medicine is missing

2. Why medicines accumulate

The fact that people take more and more tablets over the years is rarely the result of a single wrong decision. Usually several mechanisms work together:

• Many prescribers: GP practice, cardiology, orthopaedics, hospital — each one treats “its” condition, and nobody necessarily sees the whole picture.
• “Temporary” becomes permanent: a stomach protector started in hospital, or a sleeping pill from a difficult period, simply carries on.
• Guidelines add up: each guideline recommends sensible medicines for its own condition. With several conditions, this quickly adds up to a combination that has never been studied in any single trial.
• Over-the-counter products come on top: painkillers, sleep aids, food supplements — often without the practice or pharmacy knowing about them.
• The prescribing cascade: a side effect is not recognised as such and is treated with another medicine.

The prescribing cascade: typical examples

The cascade is one of the most important reasons why a review is worthwhile. Some classic patterns:

Not every follow-up prescription is wrong — sometimes it is the best solution, for example a laxative alongside necessary opioid treatment. What matters is that the chain is looked at consciously: would it be better to change the original medicine instead of adding a second one?

3. When a review makes particular sense

As a general rule, it is worth looking at your long-term medication at least once a year. In certain situations you should actively ask for a review:

• Five or more long-term medicines — from this number on, the risk of interactions and dosing errors rises noticeably.
• After a hospital stay — new medicines are added, old ones are swapped, and the list often no longer matches the plan at your GP practice.
• New complaints such as dizziness, falls, tiredness, forgetfulness, constipation or loss of appetite — they may be side effects. More on this under Dizziness from medications.
• A change in your circumstances — marked weight loss, declining kidney function, needing care or a serious new diagnosis all shift the balance of benefits and risks.
• Treatment goal reached — the reason for a medicine no longer applies, for example gastritis that has healed or a crisis that is over.
• You no longer know what it is for — the simplest and most common reason of all.

4. Typical candidates for review

The following overview lists drug groups that are often discussed in medication reviews — not because they are bad, but because their balance of benefit and risk can change over time. For people aged 65 and over, the PRISCUS 2.0 list brings together active substances that are considered potentially inappropriate in older age and names alternatives.^² Whether anything is changed in your case is always decided by your treating practice.

5. How to prepare for your medication review

Even the best review fails if the list is incomplete. The most important contribution you can make yourself is therefore a complete overview.

The bag method

Put all the medicines you take into a bag and bring them to the appointment — this is often called a “brown bag review”. This explicitly also includes:

• over-the-counter products, including those you only take occasionally
• ointments, eye and nose drops, sprays, patches, inhalers
• food supplements, vitamins, herbal products
• as-needed medicines, for example for pain or for sleep

Herbal remedies are forgotten particularly often, even though some have marked interactions. The guide Herbal medicines explains why.

Five questions about each medicine

• What for? Which condition or goal lies behind the medicine?
• Since when and from whom? Who prescribed it, and was it intended as long-term treatment?
• Until when? Was there a planned end date that has been forgotten?
• How do I notice it working? Are there readings or complaints that have improved?
• What bothers me? Which complaints could be side effects?

Also note down your current readings (blood pressure, blood sugar, weight) and what matters to you — for example fewer tablets, less tiredness or a simpler dosing schedule. How to prepare well for the appointment as a whole is covered in the guide Preparing for a doctor’s appointment.

6. Who reviews your medication with you — and which questions you can ask

Your GP practice as navigator

The GP practice is usually the place where all the threads come together. It can weigh up prescriptions from different specialties against each other and consult with colleagues. For medicines prescribed by a specialist practice, the decision is usually made jointly.

The pharmacy as a second pair of eyes

Since 2022 there has been a pharmaceutical service called “extended medication advice for polymedication” (Erweiterte Medikationsberatung bei Polymedikation): anyone who takes at least five prescribed, systemically acting medicines on a long-term basis can use it at participating pharmacies — the costs are covered by statutory health insurance, usually once within twelve months.^⁵ Among other things, the pharmacy checks for interactions, duplicate prescriptions and problems with use, and passes its findings on to you and, if you wish, to your practice. Everything else about this is in the guide Medication review at the pharmacy.

Questions you can ask

• “Do I still need this medicine today — or was it meant for a particular period?”
• “What would happen if we reduced it or left it out?”
• “Is there an alternative with fewer side effects?”
• “Could my complaint be coming from one of my medicines?”
• “If I want to take fewer tablets: which ones are the most important?”
• “How will we know whether stopping is going well — and what do I do if it isn’t?”

These questions are not a vote of no confidence. Good practices value patients who think along with them — in the end the decision is made together, while the medical responsibility lies with the practice.

7. Step by step: how deprescribing is done safely

Once it has been decided that a medicine should be reduced or stopped, a plan follows. This is what a safe process typically looks like:^¹

1. Check the complete list. The practice or pharmacy goes through all of your medication, not just individual products.
2. Set priorities. Medicines with the highest risk of harm or the lowest recognisable benefit come first.
3. One change at a time. If several things are changed at once, it is impossible to tell which change triggered a new complaint.
4. A written tapering plan. Which dose applies from when, and how long does each step last? Many medicines are reduced over weeks, some over months.
5. Agree on monitoring. Which complaints or readings will you keep an eye on — and for how long?
6. Agree a plan B. Which signs mean you should get in touch, and when do you go back to the previous dose?
7. Document and inform. Update your medication plan, sort out old packs, and let specialist practices and your pharmacy know about the change.

8. What deprescribing achieves — and what it does not

The honest answer: the idea is well founded, but the evidence is mixed. Studies show that supervised reduction is usually possible safely and can reduce the number of medicines. Whether it also reliably makes hospital admissions, falls or deaths less frequent is supported to differing degrees depending on the study and patient group. The benefit is clearest where a medicine demonstrably causes problems — for example a sedative in someone who falls repeatedly.

The other side matters too: a good review looks not only for “too much” but also for “too little”. The internationally used STOPP/START criteria therefore explicitly name, alongside potentially inappropriate prescriptions, useful treatments that older people are often missing — such as anticoagulation for atrial fibrillation or osteoporosis treatment after a fracture.^⁶

9. Special situations: older age, care, hospital, planning a pregnancy

Older people

With age, the kidneys and liver work more slowly, the body contains less water, and the brain reacts more sensitively to some active substances. At the same time the number of diagnoses rises. That is why regular review is especially valuable from the age of 65. The guide Medications in old age offers more background.

Care homes and care at home

In care settings, as-needed medicines and psychotropic drugs are often added, and their use should be questioned regularly. Relatives and carers are allowed — and encouraged — to ask. What residents are entitled to is described in the guide Medications in care homes.

After a hospital stay

In hospital, medicines are often started for acute reasons — stomach protection during treatment, sleeping pills in the unfamiliar surroundings, a temporarily higher dose. The discharge letter is therefore a good opportunity to ask specifically at your next GP appointment which of these should stay long term.

End of life and limited life expectancy

When the remaining lifetime is limited, goals shift: medicines whose benefit only shows after many years — for prevention, for example — lose importance, while quality of life and symptom relief gain it. These conversations are not easy, but they often bring noticeable relief.

Planning a pregnancy and pregnancy

Some long-term medicines should be switched before a planned pregnancy. This is not about stopping on your own, but about planning in good time with your practice. More on this under Medications during pregnancy.

10. How brite helps you review your long-term medication

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