MyDeprescriber.com

MyDeprescriber.com

por MyDeprescriber.com

Medicina Salud mental

Could your newest symptom come from a pill you already take?

A prescribing cascade starts when a side effect of one drug is misread as a new medical condition and a second drug is prescribed to treat it. The term comes from a 1997 BMJ paper by Paula Rochon and Jerry Gurwitz. This episode, built from our written guide, walks through the classic example: a calcium channel blocker such as amlodipine causes ankle swelling, the swelling is treated with a diuretic, and nobody reconsiders the first drug. In older adults with high blood pressure, that cascade was linked to a 21% relative increase in emergency department visits and hospitalizations within 90 days. It covers why cascades stay hidden (the two prescriptions usually come from two different clinicians, the side effect can take weeks to months to appear, and medication lists are sorted alphabetically rather than by start date), the nine high-priority cascades on the ThinkCascades list, which include benzodiazepines, antipsychotics and SSRIs or SNRIs, and the question to ask at every new symptom: could it be caused by a drug the person is already taking? It also explains why unwinding a cascade starts with the first drug, one change at a time, with a gradual taper for medicines that carry withdrawal risk. Read the full guide: Prescribing Cascades: How to Spot and Unwind Them. To find someone trained in this work, see the MyDeprescriber provider directory. The hosts on this episode are AI-generated from the written guide. Educational only, not medical advice. Never stop a medication without your provider. If you are in crisis in the US, call or text 988.

Latuda leaves your body in days. Why should the taper take months?

Lurasidone (Latuda) is an antipsychotic used for schizophrenia and for depressive episodes of bipolar I disorder. It has an elimination half-life of about 18 hours and leaves the body within a few days, so stopping it suddenly can bring on withdrawal symptoms fast. This episode, built from our written guide, looks at what the research says about stopping: about half of people who stop an oral antipsychotic abruptly get withdrawal symptoms, and relapse risk clusters in the weeks and months after stopping. The hosts then walk through how a slower taper is built: NICE's minimum of at least 4 weeks as a floor rather than a target, the brain-imaging curve that makes the last few milligrams do the most work at the receptor, cutting by about a quarter (or half) of the most recent dose so each step gets smaller as the dose gets lower, planning early for the smallest 20 mg tablet, why Latuda has to be taken with a meal of at least 350 calories, and why NICE recommends monitoring mood and mental state for 2 years after the last dose. Read the full guide: How to Safely Come Off Lurasidone (Latuda). To find someone trained in this work, see the MyDeprescriber provider directory. The hosts on this episode are AI-generated from the written guide. Educational only, not medical advice. Never stop a medication without your provider. If you are in crisis in the US, call or text 988.

Does Benadryl still help you sleep after the first week?

Diphenhydramine is the sleep ingredient in Benadryl, ZzzQuil and Tylenol PM, and many people end up taking it every night for months. This episode looks at what the research says about that habit: why the drowsiness fades within days of regular use, why the American Academy of Sleep Medicine suggests clinicians not use it for insomnia, and why the question matters even more for adults over 65. The hosts then walk through coming off it after long nightly use: a gradual step-down of 25 to 50 percent of the daily dose every one to four weeks, a slower final step, what mild discontinuation symptoms can feel like in the first few days, and why the American College of Physicians recommends cognitive behavioral therapy for insomnia (CBT-I) as the first treatment for the sleep problem underneath. Read the full guide: How to Safely Come Off Diphenhydramine (Benadryl) for Sleep. To find someone trained in this work, see the MyDeprescriber provider directory. The hosts on this episode are AI-generated from the written guide. Educational only, not medical advice. Never stop a medication without your provider. If you are in crisis in the US, call or text 988.

Three blood pressure pills at 86: when is one too many?

Treating high blood pressure in later life works. This episode is about the narrower question that follows: what to do when someone is 80 or older, already sitting well below target on two or more medicines, and getting dizzy on standing or falling. The hosts walk through who fits that picture, what the OPTIMISE trial found when one medicine was removed from 569 adults aged 80 and older, and what the 2025 Cochrane update adds. They are careful about what the evidence does not show. Removing a medicine here is a de-intensification to reduce burden, not a treatment with proven outcome benefit, and the DANTE trial found that stopping does not improve memory or daily function. The episode also covers which medicine tends to come off first, the four-week review, and why restarting one is a normal result rather than a failed attempt. Read the full guide: Deprescribing Antihypertensives in Older Adults. To find someone trained in this work, see the MyDeprescriber provider directory. The hosts on this episode are AI-generated from the written guide. Educational only, not medical advice. Never stop a medication without your provider. If you are in crisis in the US, call or text 988.

Coming Off Paroxetine (Paxil): Why It Is Different, and How a Slow Taper Is Built

Paroxetine leaves the body fast. That is why missing a single dose can leave you dizzy, sick, or strangely off by the next afternoon, and why coming off Paxil takes more planning than coming off most other antidepressants. In this episode: what makes paroxetine different from other SSRIs; what withdrawal can feel like, using the reactions the FDA label itself lists; how a slow, liquid-based taper is usually built with your provider; how to tell withdrawal from relapse; what helps while you are tapering; and when to call your provider right away. Read the full written guide: mydeprescriber.com/how-to-safely-come-off-paroxetine-paxil Find a provider trained in deprescribing: mydeprescriber.com/find-a-provider The hosts of this episode are AI-generated from our written guide. Educational only, not medical advice. Never stop a medication without your provider. If you are in crisis in the US, call or text 988.

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