table 2
Examples of STOPP/START criteria as defined by STOPP START toolkit 42
System STOPP START
Gastrointestinal Prochlorperazine and metoclopramide with
Parkinson’s. Step down proton pump inhibitors (PPIs) at
treatment for >eight weeks PPI in severe GORD or stricture requiring dilation
Cardiovascular Furosemide as first-line monotherapy for hypertension Statin therapy with a documented history of coronary,
cerebral or peripheral vascular disease and life
expectancy >five years
Respiratory First generation antihistamines – if patient has fallen in
last three months Regular inhaler beta 2 agonist or anticholinergic agent
for mild to moderate asthma or COPD
table 3
Summary of interventions noted for deprescribing
Paper Population Key interventions Findings Follow up
Garfinkel and Mangin 16 Elderly patients referred
for geriatric assessment Discontinued 311
medicines in 64 patients
(average 58% of drugs/
patient) 2% medicines restarted Mean follow up at
19 months
Garfinkel et al 17 Disabled geriatric patients
resident in a nursing
home Discontinued 332
medicines in 119 patients Drug discontinuation
failure occurred in 10% all
drugs
24% reduction in
mortality
Approximately 20%
reduction in need for
referral to acute care One-year follow up to
assess mortality
McKean et al 18 Patients aged >65 years
admitted to general
wards with eight or more
medicines Discontinued 34.3% of
medicines 1.2% medicines were
restarted Follow up at median of
78 days
Martin and
Tannenbaum 19 Patients aged >65 years
with polypharmacy
and on at least one
benzodiazepine Provided patients with
EMPOWER brochure –
deprescribing tool Complete discontinuation
of benzodiazepines
achieved in 32% of
patients with mild
cognitive impairment and
38% of patients with no
impairment Three-month follow up
Tinetti et al 21 Patients aged >70 years
with at least one risk
factor from a defined
criteria Either or combination of:
medicines optimisation,
behavioural instructions,
exercise programmes or
social visits 12% reduction in falls
Reduction in risk factors Follow up at one year
Campbell et al 23 Patients aged 65 years
and on psychotropic
medication Gradual withdrawal of
psychotropic medicines.
A home-based exercise
programme Reduction in risk of falls 44 weeks
Kutner et al 25 Adults with life expectancy
of one month–one year;
statin therapy for at least
three months Statin therapy stopped Improved quality of life
No significant difference
in mortality Monthly for up to one year
Avraham and Biglow 35 Average age 65.6 years Weaning down of PPIs 90% patients achieved
cessation 12 weeks
22 | Issue 90 | 2018 | hospitalpharmacyeurope.com