Medstopper.com - Software to help Prescribers Cut Down on Meds & Benzos

http://medstopper.com/about.php

Interesting video, neat software, great Canadian team of doctors behind it.

"Medstopper is a tool to help clinicians and patients make decisions about reducing or stopping medications. By entering the list of medications a patient is receiving, Medstopper sequences the drugs from "more likely to stop" to "less likely to stop", based on three key criteria: the potential of the drug to improve symptoms, its potential to reduce the risk of future illness and its likelihood of causing harm. Suggestions for how to taper the medication are also provided."

Small signs of progress here.

Ali

Thank you for this, SS! I do hope that it's on the right track.

The only thing I was really concerned about was the note at the end, that the 90-year-old woman, originally on 19 pills, was tapered off all but five within a three-week period. I certainly hope her Ativan as needed wasn't one of them!

It continues to worry me that doctors taper patients off way too quickly, and a 90-year-old will have a much more difficult time as opposed to someone younger.

But you're right, small signs of progress!

God, I know Terry.  I was thinking about that too.  Benzos are so tricky and also z-drugs.  I hope by now doctors know better but I fear that only a select few.

Still, nice to see a good discussion starting to grow amongst the pharmacists as well as prescribers.  If you haven't subscribed to the "Deprescribing" twitter feed, do it!  It is great - so many good links.

I think I went on Twitter to help retweet Bernie Sanders information and I'm now mining it for benzo and z-drug information.

I think I'm planning to write to some of these doctors on the Medstoppers site.  How great that they are doing this.

Ali

Good for you, Ali!! You're doing a lot of great work!!  :thumbsup:

And, yes, it is nice to see good discussion starting. The "Deprescribing" twitter feed sounds interesting!

The Medstoppers site is offering a really great service. I just hope that good tapering schedules can be figured out!

I wrote an e-mail to Medstoppers today, SS. I want to find out what drugs the 90-year-old "very frail" woman was still on at the time of her death six months later.

Here is the list of medications that were originally prescribed to her, that were shown on the video:

Potassium chloride, 600 mg. 2x daily

Ramipril, 10 mg. daily

Metoprolol, 100 mg. 2x daily

Furosemide, 40 mg. daily

Valsartan 160 mg. daily

Digoxin 0.0625 mg. daily

Hydromorphone 3 mg. 2x daily

Vitamin D 1000 IU daily

Calcium 1250 mg. daily

B12, 250 mg. daily

Vitalux daily

Omega-3s daily

Warfarin 25 mg. daily

Atorvastatin 20 mg. daily

Zopiclone 3.75 mg. daily

Sennosides 12 mg. daily

Nitro-patch 0.4 mg. qhs

Atrovent

Flovent

As-needed drugs:

Ativan

Nitro spray

Hydromorphone

Gravol

I'm concerned that the message MedStoppers is sending to the public, that patients can be taken off their drugs quickly (in the video, after introducing some of the MedStoppers, the message given after their pictures was "It doesn't take her long to stop drugs") is potentially very harmful.

When I added in the three bp pills I was on as well as Ativan - Valsartan, Diltiazem, and Labetalol - the chart told me to reduce the pills by 50% every 1 to 2 weeks. For Ativan, I was to reduce the drug 25% each week unless complications occurred. At that point: "If intolerable withdrawal symptoms occur (usually 1-3 days after a dose change), go back to the previously tolerated dose until symptoms resolve and plan for a more gradual taper with the patient. Dose reduction may need to slow down as one gets to smaller doses (i.e. 25% of the original dose). Overall, the rate of discontinuation needs to be controlled by the person taking the medication."

A big part of the reason I'm also concerned is that, from my own experience, doctors know next to nothing about tapering, and that includes bp drugs. I'm in my 60s, getting up there in age, and I feel it's important for doctors, pharmacists,and the patients' families to know that careful tapering is extremely necessary off most pharma drugs, if not all.

For many of the elderly, their children are in charge of their medications. If their children followed these guidelines, it's very likely that there would be quite a few of the elderly going through lots of w/d symptoms/rebound that might not even be recognized by their children.

I'm sorry to carry on like this, SS, as I'm really glad that you posted info about MedStoppers. I just think that the tapering schedules are much, much too fast. Even if I hadn't been in w/d, the rebound from my bp pills, following the chart, would have been unbearable and could potentially cause strokes for a lot of older/elderly people, myself included. I ended up doing much slower tapers than doctors would have told me to do, and even so, especially with Labetalol, it took more than a month after tapering to start calming down.

Terry,

I completely agree.  I'm glad all of the doctors on that site are public, we can write to them all.  I believe all of them have Twitter accounts.

It starts here.  With all of us.  Particularly those of us who have direct experience.  The doctors need to know and they don't.  Not yet.  Not all of them.

This is why I believe it is going to take a concerted efforts on all our parts to come together as patient groups and speak out.  Not to take anything away from BBs, but it is only part of the solution.  We need to speak out as real people in real life.

I am very concerned about the rapidity of their discontinuation protocols.  They need to know about the data and about our collective experience.  I wish the Cochrane Collective would take this on the way they've tackled many other medications.  I'm going to directly approach them as well.

This is a big problem.  I feel very sorry for that 90 year old too, it seems anecdotally her quality of life improved but OMG benzos and z-drugs cannot be tapered that quickly for anyone.

I am glad that this is becoming more widely discussed.  Doctors are the gatekeepers here along with the pharmacists - in a way, they ARE the problem.  Whatever happened to "first do no harm?".

Ali

Thanks so much, SS!!

Yes, I wonder also about the "first do no harm." Where did it go?

You're absolutely right that we have to talk about what we've learned. Much of what we've learned is still not known to doctors and pharmacists.

I know the Cochrane Collective was mentioned on BB before. I'll have to look that up again.

Once I find out what pills the 90-year-old was still taking at the time of her death, I'll let you know. I just hope that she wasn't taken off the Ativan, z-drug, and bp pills!

 

Yes, I wonder also about the "first do no harm." Where did it go?

 

Don't you know Terry, that oath has been changed to, "first do harm."

Bets

That sounds right, Bets!! I'm angry too!! 

Most doctors aren't getting it right when it comes to ANYTHING about drugs.