TOPLINE

Among older adults who discontinued central nervous system (CNS) active medications, substitutions occurred for approximately 10% of drug discontinuations, with more than one quarter of these substitutions involving potentially inappropriate medications such as tricyclic antidepressants, benzodiazepines, and hydroxyzine.

METHODOLOGY

• Researchers conducted a secondary analysis combining data from intervention and control arms of a deprescribing trial, which tested a health system-embedded intervention aimed at reducing prescription of CNS-active medications.
• They included 2182 participants (average age, 70.5 years) who were chronic users of the medications.
• Chronic use was defined as pharmacy dispensing for at least two thirds of the prior 90 days.
• Discontinuation of CNS-active medications was defined as having no prescription fills for 90 days, and substitution occurred if a new alternative medication was prescribed during the 30 days before or 60 days after discontinuation.
• Researchers assessed the proportion of individuals who discontinued and substituted the medication and characterized the substitutions as potentially inappropriate or not based on the American Geriatrics Society Beers Criteria.
• Benzodiazepines, tricyclic antidepressants, Z-drugs, and hydroxyzine were considered potentially inappropriate.

TAKEAWAY

• Of the 2415 target medications prescribed at baseline, 18.3% were discontinued during follow-up of nearly a year; discontinuation rates varied by medication class from 8% for opioids to 49.7% for skeletal muscle relaxants.
• Substitutions were made for 9.5% of the drug discontinuations and included 49 medications, with substitution rates varying from 5.1% for benzodiazepines to 16.7% for Z-drugs.
• Of the substitutions made, 26.2% were for a potentially inappropriate medication such as tricyclic antidepressants, benzodiazepines, and hydroxyzine.
• The other common substitutions were gabapentin (19.0%), selective serotonin norepinephrine reuptake inhibitors (19.0%), and trazodone (11.9%).

IN PRACTICE

“[The study] finding suggests that additional guidance for prescribers regarding safer alternative medications is warranted,” the authors wrote.

SOURCE

The study was led by Shelly L. Gray of the Department of Pharmacy at the University of Washington in Seattle. It was published online as a brief report on June 11, 2026, in the Journal of the American Geriatrics Society.

LIMITATIONS

Defining when a drug was substituted by another was challenging because it depended on when new prescriptions were filled relative to discontinuation of the target medication. Combining data from intervention and control groups meant that any stop in medication could be due to the intervention or normal patterns.

DISCLOSURES

This study was funded by CDC. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.