Neuropsychiatric Disease and Treatment
Open access peer-reviewed scientific and medical journals.
Dove Medical Press is now a member of the Open Access Initiative
An Author's Guide
A guide to help authors get their paper published.
Support Open Access and Dove Press
Promotional Article Monitoring - further details
Favored Author Program
Real benefits for authors, including fast-track processing of papers.
Polypharmacy or medication washout: an old tool revisited
(6164) Total Article Views
Authors: Hoffman DA, Schiller M, Greenblatt JM, Iosifescu DV
Published Date October 2011
Volume 2011:7(1) Pages 639 - 648
Daniel A Hoffman1, Mark Schiller2, James M Greenblatt3, Dan V Iosifescu4
1Neuro-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, USA
Abstract: 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%–34.1% dropouts due to intolerance of the augmentation, whereas studies of medication washout demonstrated only 5.9%–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
Cannotea Citeulike Del.icio.us Facebook LinkedIn Twitter
Other articles by Dr Daniel Hoffman
Readers of this article also read:
"I was impressed at the rapidity of publication from submission to final acceptance." Dr Edwin Thrower, PhD, Yale University.
- MLA'14 -
May 16–21, 2014
- CINP World Congress
22 - 26 June, 2014
- 27th ECNP Congress
18 - 21 October, 2014
- Neuroscience 2014 Annual Meeting
November 15 - 19
- Aggressive behavior, cognitive impairment, and depressive symptoms in elderly subjects
- Critical appraisal of the role of davunetide in the treatment of progressive supranuclear palsy
- Long-term treatment of bipolar disorder with a radioelectric asymmetric conveyor
- Role of nucleus accumbens glutamatergic plasticity in drug addiction