Deprescribing

More Than a
Tapering Algorithm

Deprescribing — reducing or stopping medications that are causing harm or no longer providing benefit — is a defining focus of Dr Kenchaiah's clinical practice. The goal is not a shorter prescription list; it is a safer, more effective one.

What is Deprescribing

Deprescribing is the planned and supervised process of reducing or stopping a medication that may be causing harm or is no longer providing benefit. Initially associated with elderly care, its importance is now recognised across the lifespan and across medical specialties.

Algorithms exist for tapering benzodiazepines, opioids, and antidepressants — but they rarely account for the full complexity of polypharmacy, and they fail patients when applied rigidly without clinical judgement.

Dr Kenchaiah's experience has shown that success in deprescribing depends on far more than a dosing schedule. The most important factors are relational, not pharmacological.

Related Resources
Patient info sheet → Clinician reference → Referral for GPs → What to expect →

Relational Principles

The following are some of the relational principles that reflect what consistently determines whether a deprescribing process succeeds or fails — especially in complex, long-standing polypharmacy where standard protocols have already fallen short.

These principles have been shaped by more than two decades of listening to patients — and corroborated by the peer-reviewed literature.

Therapeutic AllianceA trusting, safe relationship between patient and clinician is the foundation of any successful deprescribing journey.[1][2]
Continuity of CareConsistent, ongoing clinical relationships reduce dropout and improve outcomes over time.[3][4]
Understanding Personal MeaningPatients often attach deep significance to their medications. Acknowledging this is essential to building readiness for change.[5][6]
Recovery-Goal ExplorationDeprescribing is most effective when aligned with what the patient actually wants their life to look like.[7][8][9]
Flexibility in ApproachIn complex polypharmacy, rigid protocols fail. Clinical judgement and adaptability are indispensable.[7][9][10]
A note on appropriate polypharmacy Not all polypharmacy is a problem, and deprescribing is not the right answer for every patient or every medication. Some combinations are carefully calibrated and clinically necessary — reducing them without good reason can destabilise well-controlled conditions. The decision to deprescribe is always weighed against the risk of not doing so, and always made collaboratively. The goal is not a shorter list; it is a safer, more effective one.
  1. Toura et al. (2018). Therapeutic relationship & psychopharmacology. Psychiatr Serv.
  2. Zilcha-Mano et al. (2019). Alliance & expectancy in treatment. Front Behav Neurosci.
  3. Lampe et al. (2023). Continuity of care & polypharmacy. Drugs Aging.
  4. Maarsingh (2024). Wall of evidence for continuity of care. Ann Fam Med.
  5. Tutter (2006). Medication as object. J Am Psychoanal Assoc.
  6. Fain et al. (2008). Psychotropic medication & object relations. Int J Group Psychother.
  7. Scott et al. (2015). Reducing inappropriate polypharmacy. JAMA Intern Med.
  8. Reeve et al. (2013). Patient barriers to deprescribing. Drugs Aging.
  9. Reeve et al. (2014). Patient-centred deprescribing process. Br J Clin Pharmacol.
  10. Goldberg et al. (2026). Deprescribing psychotropics consensus. JAMA Netw Open.