What new guideline?
A draft NHMRC guideline titled Evidence-Based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine in People with Dementia. This guideline and associated documents open for public consultation until 6th July 2017.
Who developed it?
The University of Sydney, NHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People and the Bruyère Research Institute/Deprescribing Guidelines in the Elderly Project.
Who is affected?
These guidelines may affect you, only if you or a loved has dementia. The guidelines discuss deprescribing, that is withdrawing, dementia medications in people with established dementia who have been taking them for over a year. Deprescribing would be undertaken as a trial initially. People whose condition deteriorates drug the trial period would recommence their medication at the end of the trial.
Who makes the decision to deprescribe?
Deprescribing would be a shared decision made in consultation with the person, their family/carer and the person’s treating clinician. The values, preferences and experiences of the person with dementia and/or their carer/family would also be taken into account in decision making. Decisions would be individualised, that is decisions would be made on a case by case basis.
Which medications?
Medications affected by this guideline include all dementia medications available currently in Australia. These include the cholinesterase inhibitors (donepezil, rivastigmine, galantamine, with trade names such as Aricept, Exelon, Reminyl) and the NMDA receptor blocker/antagonist memantine (e.g. trade name Exiba).
Why deprescribe?
It is important to carefully balance potential risk and benefits when using any medication. It is anticipated that a trial withdrawal may help identify people for whom cognitive benefits have ceased (that is the medications have stopped working), who could stop their medication with “minimal clinically relevant consequences”. Deprescribing is not about ‘giving up hope’, but rather aims to manage the long-term risk (e.g. side effects) and benefits of dementia medications.
How is deprescribing done?
Medications are ‘tapered’. This means that the dose of the medication is slowly reduced until the person ceases taking the medication completely. Tapering is done under medical supervision with regular monitoring and follow up.
Can I have a say?
Anyone, including people with dementia, are welcome to comment on the draft guidelines. The draft guidelines are open for public consultation until 6th July 2017.
Reeve E et al. Evidence-based clinical practice guideline for deprescribing cholinesterase inhibitors and memantine. Copies of draft guideline and associated documents: http://sydney.edu.au/medicine/cdpc/news-events-participation/deprescribing-guideline.php