Discontinuing Medications at the End of Life

Archives of Internal Medicine published a good, comprehensive article about reconsidering medication appropriateness late in life. While mostly from a Geriatrics perspective there is obvious overlap for any patient with prognosis of hours to months as well. One of the great things about an article like this is that it begins a discussion and framework that will hopefully be molded and shaped into future research studies on how to best discontinue medications at the end of life.

There are very few articles on the subject. Annette Vollrath and I started a series to review d/c of meds in various areas, but it proved to be a monumental task. So far we have one article published on the discontinuation of lipid lowering agents.

The commentary article focuses on four pillars for deciding when a medicine is appropriate near the end of life.

Remaining Life Expectancy
Time Until Benefit
Goals of Care
Treatment
Target

The was no strong focus on ethics in the article but really more of a utilitarian approach. I hope to see more articles like this to help guide our medical decisions.

I have seen in the fentanyl patch insert that it strongly advises to never convert someone from a fentanyl patch to other opioids because it has not been well studied. Well that is a pretty convenient 'dead-end' approach to keeping someone on your medication forever! I have thought about suggesting to the FDA a new section for medication inserts:

"Indications and Methods for Discontinuation"

I know this is unlikely to happen anytime soon, but a boy can dream.