23 May 2024 TI Blog Update: May 2024
Climate change may be drying up many rivers in British Columbia and threatening our salmon runs, but at least these “merpeople” still have no difficulty finding “prescribing cascades“. Two weeks ago, British psychiatrist Mark Horowitz (MBBS, PhD) presented an erudite 1-hour webinar on long-lasting antidepressant withdrawal symptoms and his recommended Maudsley (Hospital) Deprescribing Guideline approach to “hyperbolic tapering.” The recording of this webinar is now freely available on our website and in our YouTube channel.
In 2023 we launched a new webinar series to tackle the clinical problem of polypharmacy. The first 6 presentations (scroll down to see a list with links) attracted almost 2,000 participants from all 6 inhabited continents and a surprising range of countries. The audience usually includes pharmacists, physicians, nurse practitioners and nurses, health educators and regulators, as well as lay people.
We are pleased to invite you to register for the seventh Deprescribing Webinar which will be held on Wednesday, June 12 at 12:00 noon PDT (convert to your local time). In this webinar, we feature again 2 cases where deprescribing seemed in order. We hope you will consider joining us for this upcoming webinar. Please also consider alerting your students or colleagues to this opportunity, whatever your field in health care. Anyone can register, at no cost. More details below and on the webinar web page.
BC Provincial Deprescribing Webinar #7
DATE: Wednesday, June 12, 2024
TIME: 12:00 to 13:00 Pacific Time PDT [convert to your local time]
MODERATOR: Dr. Tom Perry
CME CREDITS: MainPro+/MOC Section 1 credits: 1.0 (available if you attend and complete the evaluation)
REGISTRATION: https://ubc.ca1.qualtrics.com/jfe/form/SV_1KW6Ky9SoZBc04u
Case #1: “Personalized tapering and deprescribing of an antidepressant”
An apparently simple case of a young woman who wanted to stop taking desvenlafaxine, the active metabolite of venlafaxine. Community pharmacist Shawn Gill will show us how he helped this patient to approach a very gradual and orderly taper under supervision, with the support of her psychotherapist – following the approach suggested by Dr. Horowitz. If you are unaware of the difficulty some people experience in stopping antidepressants, or worked with patients to overcome that, you may find this case particularly thought-provoking.
Case #2: “Where do we begin? Digging deep and taking the reins. Deprescribing in the context of medical and psychiatric complexity”
This is a much more complicated case, presented by two young family physicians from McMaster University in Ontario, Marrison Marwood and Shayna Henry.
Imagine how YOU might react if faced in a 10-minute appointment with a man with complex psychiatric and medical history who arrives with this list of complaints (as presented to Dr. Marwood) and a similarly challenging medication list:
Medication list as shown in electronic medical record before May 2022 appointment (drugs highlighted may be redundant – but unknown to new primary care doctor):
- Atorvastatin 20mg/d
- Bisacodyl as directed
- Fenofibrate 145mg/d
- Ramipril 10mg/d
- l-thyroxine 25mcg/d
- Metformin 1g twice/d
- Semaglutide – 1mg/week (Obesity clinic, discharged)
- Methylphenidate SR 54mg/d (morning)
- Olanzapine 10mg/d (evening)
- Pramipexole 0.25mg twice/d
- Silodosin 4mg/d
- Vortioxetine 10mg/d
- Zopiclone 7.5mg/d (bedtime)
- HCTZ 25mg/d
- Insulin glargine 100units/d
- Gliclazide 60mg/d – but stopped March 2020
- Methylphenidate CR 36mg/d (? replaced with lixdexamfetamine)
- Empagliflozin 10mg/d – but stopped due to urinary symptoms
- Tamsulosin 0.4mg/d ???
- Pantoprazole 40mg twice/d
Drs. Marwood and Henry, plus multiple consultants, have probably devoted > 100 hours to working with this outpatient over the last 2 years – but on June 12th, they will show us in about 20 minutes how they approached this challenge!
Previous attendees in this series have found the Deprescribing Webinars both provocative and inspiring. We aim to encourage self-assessment of our own approaches, not only in clinical practice but in how we try to teach cautious and rational prescribing and deprescribing of medications. All webinars are free of charge, and accredited in Canada for Continuing Professional Development.
Links to the previous sessions in the Deprescribing Webinar series (links include the slide decks and video recording for each session):
- February 8, 2023: BC Provincial Deprescribing Series Webinar #1
- April 19, 2023: BC Provincial Deprescribing Webinar Series #2
- June 14, 2023: BC Provincial Deprescribing Webinar Series #3
- September 20, 2023: BC Provincial Deprescribing Webinar Series #4
- November 8, 2023: BC Provincial Deprescribing Webinar Series #5
- March 13, 2024: BC Provincial Deprescribing Webinar Series #6
If you are interested in the methods used for synthesizing the evidence, we invite you to join our Methods Speaker Series Webinar: Preprints: Catalyzing Equity and Integrity in Scientific Discourse on Wednesday, May 29th at 12:00 noon PDT [convert to your local time] in which Larissa Shamseer, a CIHR-funded postdoctoral methods researcher working with the Knowledge Translation Program at Unity Health Toronto, will explore how preprints foster transparency, accelerate scientific progress, and promote inclusivity by amplifying voices often marginalized in traditional publishing. She will also consider the safeguards and practices necessary for maintaining research integrity within the preprint ecosystem.
Here too is an advance notice of our annual Best Evidence course, which will be held in person in Vancouver (and remotely by Zoom) on Saturday October 19, 2024. We plan an intensive in-person, practical workshop on deprescribing for the afternoon of Friday, October 18, 2024 – also in Vancouver. If you are interested to participate in the October 18, 2024 Deprescribing Workshop, feel free to contact: tom.perry@ubc.ca
If you are a BC family physician or nurse practitioner, we invite you to join over 1,000 of your colleagues who have signed up for the TI Portrait program at our secure online portal: https://secure.ti.ubc.ca/ Log in to view your Portraits and/or related materials, or sign up if you haven’t already. Questions? Email the TI Portrait team at portrait@ti.ubc.ca We welcome your feedback.
We hope to “see you” soon by Zoom, or in person this fall.
Thomas L. Perry MD, FRCPC
Editor, Therapeutics Letter
Therapeutics Initiative
University of British Columbia, Vancouver
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