U of A Researcher Urges Routine Deprescribing Reviews to Reduce Polypharmacy Harm

Medication lists should not be allowed to grow unchecked. In guidance published September 25, 2026, University of Alberta pharmacy researcher Dr. Cheryl Sadowski argues that regular deprescribing reviews can reduce medication-related harm while preserving treatments that still provide clear benefit.

Why deprescribing belongs in routine care

Deprescribing is a structured clinical process: review each medicine, confirm its current indication and benefit, identify harms or burden, and—when appropriate—reduce, substitute or stop therapy with a monitoring plan. It is not simply “taking medicines away,” and it should not be attempted by patients on their own.

The University of Alberta article notes that as many as one in four older adults in Canada were taking 10 or more medication classes in 2021. Higher medication burden can amplify drug–drug interactions, falls, confusion, sedation and adherence problems. Age alone is not the trigger, however; anyone with a complex or growing regimen may benefit from a deliberate review.

Three common review targets

Sadowski identifies sleeping medicines, proton-pump inhibitors used for heartburn and pain medicines as frequent candidates for reassessment. Long-term sedative use can contribute to confusion and falls. Extended proton-pump inhibitor use may no longer be needed once the original indication has resolved. Opioids and gabapentin used for persistent pain also warrant periodic review of benefit, function and adverse effects.

Over-the-counter products, natural health products and alcohol should be included because they can add sedation or interact with prescribed therapies. A complete best possible medication history is therefore essential before proposing any change.

Shared decisions and follow-up

A safe deprescribing plan begins with the patient’s goals and concerns. Pharmacists can help patients ask why each medicine is still being used, what benefit it is providing, whether it could be contributing to memory problems or falls, and what follow-up will occur if the dose is reduced.

Medicines that can cause withdrawal or symptom rebound must not be stopped abruptly. Changes should be coordinated with the prescriber and care team, usually one priority medicine at a time, with a clear taper schedule and a plan to restart or adjust treatment if clinically necessary.

Practice guidance for pharmacists

• Offer a medication review when patients have polypharmacy, falls, confusion, sedation, adherence difficulty or a recent care transition.
• Reconcile prescriptions, non-prescription medicines, natural health products and alcohol before identifying possible deprescribing targets.
• Confirm the current indication, benefit, treatment duration, adverse effects and patient goals for every medicine under review.
• Coordinate any taper or discontinuation with the patient, prescriber and other involved clinicians; do not advise abrupt stopping when withdrawal or rebound is possible.
• Document the agreed plan, monitoring parameters and follow-up date, and reassess symptoms, function and patient priorities after each change.