Polypharmacy or medication washout: an old tool revisited

Daniel A Hoffman1, Mark Schiller2, James M Greenblatt3, Dan V Iosifescu41Neuro-Therapy Clinic Inc, Denver, CO; 2Mind Therapy Clinic, 2299 Post Street, Suite 104A, San Francisco, CA; 3Comprehensive Psychiatric Resources, Waltham, MA; 4Mood and Anxiety Disorders Program, Mount Sinai School of Medicine...

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Autores principales:	Hoffman DA, Schiller M, Greenblatt JM, Iosifescu DV
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2011
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/9301e3d09b4f4b06ba0469ed4544abfb
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spelling	oai:doaj.org-article:9301e3d09b4f4b06ba0469ed4544abfb2021-12-02T00:04:22ZPolypharmacy or medication washout: an old tool revisited1176-63281178-2021https://doaj.org/article/9301e3d09b4f4b06ba0469ed4544abfb2011-10-01T00:00:00Zhttp://www.dovepress.com/polypharmacy-or-medication-washout-an-old-tool-revisited-a8519https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Daniel A Hoffman1, Mark Schiller2, James M Greenblatt3, Dan V Iosifescu41Neuro-Therapy Clinic Inc, Denver, CO; 2Mind Therapy Clinic, 2299 Post Street, Suite 104A, San Francisco, CA; 3Comprehensive Psychiatric Resources, Waltham, MA; 4Mood and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, NY, USAAbstract: 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%&ndash;34.1% dropouts due to intolerance of the augmentation, whereas studies of medication washout demonstrated only 5.9%&ndash;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.Keywords: polypharmacy, medication washout, risk of polypharmacyHoffman DASchiller MGreenblatt JMIosifescu DVDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2011, Iss Issue 1, Pp 639-648 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Hoffman DA Schiller M Greenblatt JM Iosifescu DV Polypharmacy or medication washout: an old tool revisited
description	Daniel A Hoffman1, Mark Schiller2, James M Greenblatt3, Dan V Iosifescu41Neuro-Therapy Clinic Inc, Denver, CO; 2Mind Therapy Clinic, 2299 Post Street, Suite 104A, San Francisco, CA; 3Comprehensive Psychiatric Resources, Waltham, MA; 4Mood and Anxiety Disorders Program, Mount Sinai School of Medicine, New York, NY, USAAbstract: 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%&ndash;34.1% dropouts due to intolerance of the augmentation, whereas studies of medication washout demonstrated only 5.9%&ndash;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.Keywords: polypharmacy, medication washout, risk of polypharmacy
format	article
author	Hoffman DA Schiller M Greenblatt JM Iosifescu DV
author_facet	Hoffman DA Schiller M Greenblatt JM Iosifescu DV
author_sort	Hoffman DA
title	Polypharmacy or medication washout: an old tool revisited
title_short	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_sort	polypharmacy or medication washout: an old tool revisited
publisher	Dove Medical Press
publishDate	2011
url	https://doaj.org/article/9301e3d09b4f4b06ba0469ed4544abfb
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Polypharmacy or medication washout: an old tool revisited

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