Kentucky SafeMed

Kentucky SafeMed image

Kentucky SafeMed is a program to encourage safe use of medications in children across Kentucky.  Our focus is on deprescribing psychotropic medications, to prevent unnecessary side effects. The materials available on this site were developed by health professionals from the University of Louisville, Department of Pediatrics, Child and Adolescent Health Research Design and Support Unit (CAHRDS).

All Kentucky SafeMed materials on the louisville.edu website may be reproduced as needed; however, literature content should not be altered without permission.

 

Image: Summary of Deprescribing

What is Deprescribing?

A structured approach to evaluating medications for indications, risks, and benefits with a goal of a minimum effective dose and number of medications. It can be thought of as rational prescribing.

Why Deprescribe?

Some youth take more psychotropic medications (PM) than necessary. Youth are generally at higher risk of medication adverse effects and much is unknown about long-term effects of PM on the developing brain.

 

 Contact Us

For questions about Kentucky SafeMed or more information, please contact us by email.

 Disclaimer

This project was supported by the following: Kentucky Cabinet for Health and Family Services:Department for Medicaid Services under the State University Partnership contract titled “Improving Care Quality for Children Receiving Kentucky Medicaid”, Norton Children’s Hospital, and the University of Louisville School of Medicine, Department of Pediatrics; School of Public Health and Information Sciences.

This content is solely the responsibility of the authors and does not necessarily represent the official views of the Cabinet for Health and Family Services, Department for Medicaid Services.

Resources for Providers

What is Deprescribing?

A structured approach to evaluating medications for indications, risks, and benefits with a goal of a minimum effective dose and number of medications. It can be thought of as rational prescribing.

Why Deprescribe?

Some youth take more psychotropic medications (PM) than necessary

Youth are generally at higher risk of medication adverse effects and much is unknown about long-term effects of PM on the developing brain.              

Psychotropic Medications:

  • Antipsychotics
  • Mood Stabilizers
  • Antidepressants
  • Antianxiety/sedative/hypnotics
  • Stimulants
  • Alpha-agonists

How to Deprescribe

Step 1 - Review factors related to the youth which might favor deprescribing

  • Assess for psychosocial stability and level of function
    • How long has the youth been doing well?
  • Assess the natural course of condition treated
  • Evaluate medications
    • 4 or more medications
    • More than 1 medication per drug class
  • Consider the age of the youth
    • Under 6 years old
  • Is psychosocial therapy available and helpful?
  • Assess for other health conditions
    • Pregnancy, drug abuse, illness, etc.
  • Youth/family request, click here for a shared decision guide

Step 2 - Review medication history              

Step 3 - Assess each medication for risk/benefit

  • Possible reasons to taper/discontinue:
    • Lack of indication or target symptoms
    • Lack of benefit – target symptoms have not improved
    • Low quality evidence to support the use
    • Redundant medication class
    • Adverse effects
    • Non-compliance
    • Dosing outside of accepted guidelines (too high/low)
    • Medication is being used to treat side effects of another medication
    • Extended trial of medication without an attempt to taper

Step 4 - Prioritize a medication to deprescribe   

Step 5 - Implement taper and monitor  

  • See specific drug class algorithms for guidance
  • Include deprescribing as part of an overall treatment plan which includes therapy and crisis planning (more information)

Additional Resources

 

Resources for Parents or Caregivers


What is Deprescribing?

A chance to look at each medicine your child takes to help you and your provider know why they take it, and the pros and cons of taking it. The goal is to take the right amount of medicine needed to keep your child as healthy as possible.

Why Deprescribe?

  • Some children take more medicines than needed
  • The younger your child, the less we know about how medicines effect their body
  • Your child may have side effects from medicines
  • Things can change, so your child’s medicines might need to change too

 

What are psychotropic medicines?

These medicines are used to treat mental health problems such as depression, ADHD, and anxiety. They are used to help manage mood, anger, attention, or insomnia. It is really important to monitor and consider these medicines for deprescribing.

Some Examples:

Antipsychotics: Risperidone (Risperdal®); Aripiprazole (Abilify®)

Mood Stabilizers: Divalproex (Depakote®); Lithium

Antidepressants/Anxiety: Fluoxetine (Prozac®); Sertraline (Zoloft®)

Stimulants: Methylphenidate (Ritalin®); Amphetamines (Adderall®)

Alpha-Agonists: Clonidine (Catapres®); Guanfacine (Intuniv®, Tenex®)

What Can You Do?

  • Talk to your child’s healthcare provider
    • Ask them about your child’s medicines and whether deprescribing might help
    • Discuss how your child feels about taking medicines and about any good or bad effects they are having
    • Encourage youth to speak to the provider as well about this. Click here for shared decision guide.
  • Keep track of each of your child’s medications
    • Why are they taking this medicine? What is being treated?
    • What are possible risks or side effects?
    • How long have they been on it?
    • Do they still need it?
  • Make sure your child takes their medicines as prescribed
    • Never start, stop, or change your child’s medications without talking to their provider because it could cause the condition to get worse. Your child may need to stay on medicine to stay healthy.
    • Do not allow your child’s medicines to be shared with others

 

Steps to Take with Your Child’s Provider

1. You could discuss deprescribing if:       

  • You feel your child is on too many medicines or has taken them for a long time
  • Your child is under 6 years old
  • Things have been better for a while. Maybe therapy has helped.
  • The medicines have not helped or made your child feel worse
  • There is less stress in your child’s life now
  • There is a change in your child’s health (pregnancy, drug abuse, illness)

 

2. Medicine review 

Talk about each of your child’s medicines:

  • Who prescribed it? When? Why? Etc. 
  • What are the pros and cons?
  • How does it help? Is it causing side effects?

 

3. Making a decision         

You, the provider, and your child will decide if there are medicines to decrease or stop and what to stop first.

 

4. Follow up          

  • You and your child’s provider will plan for gradually stopping the medicine and how to watch for problems
  • Continue therapy for mood or behavior problems
  • Keep your child active to help them stay healthy

Additional Resources

Resources for Teens

What is Deprescribing?

A chance to review your medicines with your provider to know why you take it, and the pros and cons of taking it. The goal is to take the right amount of medicine needed to keep you as healthy as we can.

Why Deprescribe?

  • Some teens are taking more medicines than necessary
  • The younger you are, the less we know about how medicines effect your body
  • You may have side effects from some medicines
  • Things can change. If so, your medicines might need to change too

 

What are psychotropic medicines?

These medicines are used to treat mental health problems such as depression, ADHD, and anxiety. They are used to help manage mood, anger, attention, or sleep problems. It is really important to check these medicines to see if they can be decreased or stopped.

Some Examples:

Antipsychotics: Risperidone (Risperdal®); Aripiprazole (Abilify®)

Mood Stabilizers: Divalproex (Depakote®); Lithium

Antidepressants/Anxiety: Fluoxetine (Prozac®); Sertraline (Zoloft®)

Stimulants: Methylphenidate (Ritalin®); Amphetamines (Adderall®)

Alpha-Agonists: Clonidine (Catapres®); Guanfacine (Intuniv®, Tenex®)

What Can You Do?

Talk to your family and your healthcare provider

  • Ask them about your medicines and whether deprescribing is right for you
  • Tell them how you feel about taking your medicines and about any good or bad effects you are having. You have a right to help decide the best medicine plan for you.
  • Click here for a shared decision guide.

Keep track of each of your medications

  • Why am I taking this medicine? What problem is being treated?
  • What are possible risks or side effects?
  • How long have I been on it?
  • Do I still need it?

 

Take your medicines as prescribed

  • Never start, stop, or change your medicines without talking to your provider. It could cause your illness to worsen. You may need to stay on your medicines to stay healthy.
  • Do not share your medicines with others

Steps to take with your provider

1. You could consider deprescribing if:        

  • You feel you are on too many medicines or have taken them for a long time
  • You have been feeling better for some time. Maybe therapy has helped.
  • The medicines have not helped or made you feel worse
  • There is less stress in your life now
  • There is a change in your health (pregnancy, drug abuse, illness)

 

2. Medicine review

Talk with your provider about each of your medicines:

  • Who prescribed it? When? Why? Etc. 
  • What is the expected benefit and what are the risks?
  • How does it help? Is it causing side effects?

 

 3. Making a decision         

You and your provider will decide if there are medicines to decrease or stop and what should be stopped first.

 

4. Follow up

  • You and your provider will make a plan for gradually stopping the medicine and what to watch for if there are problems
  • Continue therapy to help you be your best
  • Exercise and activities will help you stay healthy

Additional Resources

Contact Us

For questions about Kentucky SafeMed or more information, please contact us by .

Kentucky Department for Community Based Services
(DCBS) Resources

What is Deprescribing?

An opportunity to evaluate each medication a youth takes to help everyone understand why it is prescribed along with the risks and benefits from taking it. The goal is to take the right amount of medication necessary to keep the youth as healthy as possible.

Why Deprescribe?

  • Many children involved with DCBS (foster children) have difficult, traumatic backgrounds which can lead to behavioral problems and the use of medications. But when foster children are in stable environments and receive therapy, many of their behaviors may improve and they may not need as many medications.
  • Some youth take more medications than necessary
  • The younger the child, the less we know about how medications effect their body
  • The youth may have side effects from medications

 

What are psychotropic medications?

  • These medications are used to treat mental health conditions such as depression, ADHD, anxiety and are used to help manage mood, anger, attention, or insomnia. It is especially important to monitor and consider these medications for deprescribing. 
  • Remember: Initiating or changing these medications requires your approval and informed consent

Some Examples: (click here for more information)

Antipsychotics: Risperidone (Risperdal®); Aripiprazole (Abilify®)

Mood Stabilizers: Divalproex (Depakote®); Lithium

Antidepressants/Anxiety: Fluoxetine (Prozac®); Sertraline (Zoloft®)

Stimulants: Methylphenidate (Ritalin®); Amphetamines (Adderall®)

Alpha-Agonists: Clonidine (Catapres®); Guanfacine (Intuniv®, Tenex®)

 

Medication Safety Tips

  • Never start, stop, or change medications without talking to a healthcare provider because it could cause a condition to worsen. It may be necessary to take medications to stay healthy.
  • Never share medications with others.

What can you do?

Talk to the Youth

Ask how they feel about taking medications and about any good or bad effects they are having

Talk to the Caregiver

Share as much history as possible on past mental health diagnoses and treatment.

Encourage the youth and caregiver to talk to their healthcare provider about whether deprescribing might be helpful. Click here for a shared decision guide.

Steps to take with the provider

1. Consider deprescribing if:            

  • The youth is on too many medications or has taken them for a long time
  • The child is under 6 years old
  • There is less stress in the youth’s life now, for example maybe they may be doing better in a safe, secure home
  • Things have improved with therapy
  • The medications haven’t helped or made them feel worse
  • There is a change in the youth’s health (pregnancy, drug abuse, illness)

 

2. Medication review       

You, the parent/caregiver, and the youth should talk with the child’s provider about each of the medications the youth is taking:

  • Who prescribed it? What is the diagnosis or symptoms being treated? How long do they need to take it?
  • What is the expected benefit and what are the risks?
  • How does it help? Is it causing any side effects?

 

3. Making a decision        

A decision will be made if there are medications to decrease or discontinue and what should be stopped first.

 

4. Follow up

  • You and the youth's provider will have a plan for gradually stopping the medication and making sure things remain stable
  • Continue therapy to address mood or behavior problems
  • Keep the child active with exercise and activities that help them stay healthy

Additional Resources