Polypharmacy guidance: Appropriate prescribing making medicines safe, effective and sustainable 2026-2029
Identify essential drugs (not to be stopped without specialist advice)
- Drugs that have essential replacement functions (e.g. levothyroxine)
- Drugs to prevent rapid symptomatic decline (e.g. drugs for Parkinson’s disease, heart failure)
2. Need - Identify essential drug therapy
The table below brings together some common areas where prescribers may be able to take action. This list is not exhaustive and does not replace individual clinical judgement. For more detail see Detail by therapeutic area based on amalgamated medication assessment tool.
Please note that the table below may need to be scrolled horizontally or vertically in order to view all information, depending on your device.
| Discuss with specialist prescriber before stopping | Consider seeking specialist advice before altering | Medicines with potential for dependency/ discontinuation/ withdrawal symptoms |
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Anticoagulants for metal valves Diuretics - in LVSD ACE inhibitors – in LVSD Heart rate controlling drugs (for life threatening arrythmias) Antipsychotics in schizophrenia and severe mental illness Antiseizure medication in epilepsy Steroids for replacement function DMARD Thyroid hormones Insulin in T1DM Immunosuppressants post-transplant Lithium Pyridostigmine (myasthenia gravis) Desmopressin (diabetes insipidus) |
Amiodarone Antipsychotics Antiseizure medication in epilepsy Antidiabetics DMARD Antiparkinsonian treatment Mood stabilisers, e.g. lamotrigine, lithium Insulin ADHD medications
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ADHD medications Benzodiazepines/z-drugs Antidepressants Opioids Gabapentinoids
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