Cases in Deprescribing: When to Get Rid of the Statin

Charles P. Vega, MD

Disclosures

January 31, 2019

Welcome to a new series on Medscape. Most of us spent years learning how to safely and correctly prescribe pharmacologic agents. However, little of our training has been devoted to the opposite—stopping these medications wisely and safely. And there are relatively few guidelines to assist us in discontinuing chronic medications.

In this new series, I will present a common clinical scenario drawn from my own practice, and hopefully familiar to virtually all of our readers. I will tell you what I plan to do, but I am more anxious to crowdsource a response as best practice, thanks to all of you. Please answer the polling question and contribute to the comments section with your own thoughts, particularly when you disagree with me.

Next month's article will follow up on this case and provide readers with a summary of responses.

Case Presentation

A 79-year-old man presents to your clinic for his initial primary care visit after moving into the area to be closer to his children. You note that his past medical history includes hypertension, type 2 diabetes, osteoarthritis of the knee and hip, and mild cognitive impairment. His daughter, who accompanies him to the visit, says that she wanted him closer to her due to his cognitive dysfunction.

His medications include lisinopril, amlodipine, acetaminophen, naproxen, atorvastatin, and aspirin. You ask if he takes any medications for diabetes, and the patient reports that his previous provider stopped that some time ago because he was losing weight gradually.

He has no history of cardiovascular events. His daughter is concerned because of two mechanical falls in the past month, a result of tripping on throw rugs.

The patient's blood pressure today is 156/90 mm Hg and his pulse is 75 beats per minute.

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