Deprescribing guidelines

Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine

Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine

In 2017 there were an estimated 413,000 Australians living with dementia. People with dementia often have multiple health conditions, leading to prescribing of multiple medications. However, over time, these medications can cause harm from side effects, drug-drug or drug-disease interactions, and may no longer be beneficial.

Cholinesterase inhibitors and memantine are the classes of drugs that can show benefit in the treatment of symptoms of dementia. Approximately 20,000 people with dementia in Australia are prescribed a cholinesterase inhibitor yearly with this number increasing. Appropriate use of cholinesterase inhibitors and memantine involves both prescribing these medications to individuals who are likely to benefit, and deprescribing (withdrawing) them for individuals where the risks outweigh the benefits.

Developed by the University of Sydney (Australia), in conjunction with the Bruyère Research Institute (Canada), the guideline contains seven recommendations that reflect the current evidence about when and how to trial withdrawal of cholinesterase inhibitors and memantine. The recommendations in the Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine: Recommendations were approved by the NHMRC in October 2017 and are directed at health care professionals.

The guideline emphasises the need to consider the individual including their values, preferences and goals of care. Use of this guideline has the potential to reduce medication induced harm, reduce burden of taking medications and release money, which can be spent on treatment that is more likely to be beneficial.

This guideline gives doctors and other healthcare professionals an important tool to navigate the complex process of optimising medication use in people with dementia. People with dementia and their families should always discuss plans to reduce or stop medications with their doctors and pharmacists.

Guideline and Recommendations

Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine


Evidence-based Clinical Practice Guideline for Deprescribing Cholinesterase Inhibitors and Memantine: Recommendations