%0 Journal Article
%T Safe Deprescribing Requires More Than Medication Withdrawal: A Clinical Pharmacy Framework for Sequencing, Monitoring, Therapeutic Substitution, and Restart Decisions in Complex Polypharmacy
%A Kenji Tanaka
%A Yui Kobayashi
%A Takeshi Nakamura
%J Annals of Pharmacy Practice and Pharmacotherapy
%@ 3062-4436
%D 2026
%V 6
%N 1
%R 10.51847/1t2qIL7aTs
%P 31-40
%X Deprescribing is often described as the planned reduction or discontinuation of medicines whose harms, treatment burden, or limited expected benefit no longer justify continued use. That definition is necessary but incomplete for complex polypharmacy because a safe medication change does not end when a prescription is stopped. The clinical consequences of withdrawal depend on which medicine is changed first, what other medicines and conditions remain, whether symptoms represent withdrawal or recurrence, whether the original treatment need persists, and whether a stopped medicine should later be replaced or restarted. This Comment develops a proposed clinical-pharmacy framework that treats deprescribing as a reversible, monitored process rather than a one-way medication-removal task. It integrates four decision functions: sequencing medication changes under interacting risks; monitoring for withdrawal, recurrence, and effects of treatment substitution; reassessing whether an indication still requires therapy and, if so, whether a safer substitute is appropriate; and explicitly adjudicating restart decisions. The framework distinguishes medication-level change from patient-level benefit, appropriateness flags from individualized treatment plans, and restart from automatic evidence of deprescribing failure. Its purpose is to make the post-withdrawal treatment state clinically visible and to clarify where pharmacists can contribute regimen-level reasoning, follow-up design, communication, and continuity. The framework is conceptual, not prospectively validated. Drug class, frailty, cognition, care transitions, monitoring capacity, patient priorities, and health-system resources remain important boundaries. Evaluation should therefore test both clinical outcomes and whether the proposed decision states can be implemented, measured, and revised safely across settings.
%U https://galaxypub.co/article/safe-deprescribing-requires-more-than-medication-withdrawal-a-clinical-pharmacy-framework-for-seque-ts897wwahsjy395