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Polypharmacy or medication washout: an old tool revisited

There has been a rapid increase in the use of polypharmacy in psychiatry possibly due to the introduction of newer drugs, greater availability of these newer drugs, excessive confidence in clinical trial results, widespread prescribing of psychotropic medications by primary care, and pressure to aug...

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Autores principales: Hoffman, Daniel A, Schiller, Mark, Greenblatt, James M, Iosifescu, Dan V
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215520/
https://www.ncbi.nlm.nih.gov/pubmed/22090799
http://dx.doi.org/10.2147/NDT.S24375
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author Hoffman, Daniel A
Schiller, Mark
Greenblatt, James M
Iosifescu, Dan V
author_facet Hoffman, Daniel A
Schiller, Mark
Greenblatt, James M
Iosifescu, Dan V
author_sort Hoffman, Daniel A
collection PubMed
description There has been a rapid increase in the use of polypharmacy in psychiatry possibly due to the introduction of newer drugs, greater availability of these newer drugs, excessive confidence in clinical trial results, widespread prescribing of psychotropic medications by primary care, and pressure to augment with additional medications for unresolved side effects or greater efficacy. Even the new generation of medications may not hold significant advantages over older drugs. In fact, there may be additional safety risks with polypharmacy being so widespread. Washout, as a clinical tool, is rarely done in medication management today. Studies have shown that augmenting therapy with additional medications resulted in 9.1%–34.1% dropouts due to intolerance of the augmentation, whereas studies of medication washout demonstrated only 5.9%–7.8% intolerance to the washout procedure. These perils justify reconsideration of medication washout before deciding on augmentation. There are unwarranted fears and resistance in the medical community toward medication washout, especially at the moment a physician is trying to decide whether to washout or add more medications to the treatment regimen. However, medication washout provides unique benefits to the physician: it establishes a new baseline of the disorder, helps identify medication efficacy from their adverse effects, and provides clarity of diagnosis and potential reduction of drug treatments, drug interactions, and costs. It may also reduce overall adverse events, not to mention a potential to reduce liability. After washout, physicians may be able to select the appropriate polypharmacy more effectively and safely, if necessary. Washout, while not for every patient, may be an effective tool for physicians who need to decide on whether to add potentially risky polypharmacy for a given patient. The risks of washout may, in some cases, be lower and the benefits may be clearly helpful for diagnosis, understanding medication effects, the doctor/patient relationship, and safer use of polypharmacy if indicated.
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spelling pubmed-32155202011-11-16 Polypharmacy or medication washout: an old tool revisited Hoffman, Daniel A Schiller, Mark Greenblatt, James M Iosifescu, Dan V Neuropsychiatr Dis Treat Perspective There has been a rapid increase in the use of polypharmacy in psychiatry possibly due to the introduction of newer drugs, greater availability of these newer drugs, excessive confidence in clinical trial results, widespread prescribing of psychotropic medications by primary care, and pressure to augment with additional medications for unresolved side effects or greater efficacy. Even the new generation of medications may not hold significant advantages over older drugs. In fact, there may be additional safety risks with polypharmacy being so widespread. Washout, as a clinical tool, is rarely done in medication management today. Studies have shown that augmenting therapy with additional medications resulted in 9.1%–34.1% dropouts due to intolerance of the augmentation, whereas studies of medication washout demonstrated only 5.9%–7.8% intolerance to the washout procedure. These perils justify reconsideration of medication washout before deciding on augmentation. There are unwarranted fears and resistance in the medical community toward medication washout, especially at the moment a physician is trying to decide whether to washout or add more medications to the treatment regimen. However, medication washout provides unique benefits to the physician: it establishes a new baseline of the disorder, helps identify medication efficacy from their adverse effects, and provides clarity of diagnosis and potential reduction of drug treatments, drug interactions, and costs. It may also reduce overall adverse events, not to mention a potential to reduce liability. After washout, physicians may be able to select the appropriate polypharmacy more effectively and safely, if necessary. Washout, while not for every patient, may be an effective tool for physicians who need to decide on whether to add potentially risky polypharmacy for a given patient. The risks of washout may, in some cases, be lower and the benefits may be clearly helpful for diagnosis, understanding medication effects, the doctor/patient relationship, and safer use of polypharmacy if indicated. Dove Medical Press 2011 2011-10-20 /pmc/articles/PMC3215520/ /pubmed/22090799 http://dx.doi.org/10.2147/NDT.S24375 Text en © 2011 Hoffman et al, publisher and licensee Dove Medical Press Ltd This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
spellingShingle Perspective
Hoffman, Daniel A
Schiller, Mark
Greenblatt, James M
Iosifescu, Dan V
Polypharmacy or medication washout: an old tool revisited
title Polypharmacy or medication washout: an old tool revisited
title_full Polypharmacy or medication washout: an old tool revisited
title_fullStr Polypharmacy or medication washout: an old tool revisited
title_full_unstemmed Polypharmacy or medication washout: an old tool revisited
title_short Polypharmacy or medication washout: an old tool revisited
title_sort polypharmacy or medication washout: an old tool revisited
topic Perspective
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215520/
https://www.ncbi.nlm.nih.gov/pubmed/22090799
http://dx.doi.org/10.2147/NDT.S24375
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