Canadian Deprescribing Network (CaDeN)

The Canadian Deprescribing Network (CaDeN) is a group of individuals who are committed to improving the health of Canadians by reducing the use of potentially inappropriate medicines and enhancing access to non-drug alternatives.

Funded primarily through a CIHR Partnership for Health System Improvement grant, CaDeN members represent a wide range of perspectives related to deprescribing, including patient advocates, health care professionals, academic researchers, and other health care leaders with experience in the pharmaceutical field.

Each member contributes toward the overarching goal of reducing the use of inappropriate medicines, leveraging their skills and knowledge to help with a variety of initiatives.

Ultimately, CaDeN seeks to build capacity and catalyze action to promote deprescribing all across Canada.

The first National Stakeholder’s meeting for CaDeN was held in January 2015, followed by the 2nd annual meeting in January 2016.

CaDeN is currently composed of a core working group, and 5 sub-committees.  Each is working toward two overarching goals:

  • Reduce harm by curbing the prescription of inappropriate medications by 50% by 2020
  • Promote health by ensuring access to safer pharmacological or non-pharmacological therapies

See CaDeN’s 2016 Annual Report! See French version here.

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CaDeN’s Action Plan is being rolled out and evaluated over a 4-year time period:

See CaDeN’s Deprescribing Fact Sheet for patients:

Deprescribing Fact Sheet

See CaDeN’s Deprescribing Fact Sheet for health care providers:

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Potentially harmful medications being targeted by CaDeN Three classes of medication should be considered for deprescribing by older people:

  • Benzodiazepines
  • Proton pump inhibitors
  • Sulphonylureas

Why should they be deprescribed?

  • They are over used
  • They may cause more harm than good
  • Safer alternatives exist

Benzodiazepines

  • Are used to treat anxiety or sleep problems including insomnia
  • As people age, they become more sensitive to their effects
  • These medications affect memory, concentration and balance
  • They increase the risk of falls, hip fractures and hospital admissions
  • Abruptly stopping a benzodiazepine can cause withdrawal symptoms; they need to be stopped gradually
  • Tapering protocols exist. To see a brochure for reducing sedative hypnotics for consumers, click here.

Proton Pump Inhibitors

  • Are used in the treatment of heartburn, acid reflux and gastric ulcers
  • Long term use has been linked with diarrhea, vitamin deficiencies, increased risk of fractures and infections such as C difficile or pneumonia
  • To avoid these complications, proton pump inhibitors should not be taken for more than eight weeks except for special conditions
  • To learn when and how to deprescribe proton pump inhibitors, click here for the consumer brochure, or click here to see the evidence based deprescribing algorithm.

Sulphonylureas:

  • Are used to lower blood sugar levels in the management of type 2 diabetes.
  • This class of medications, in particular the long acting sulphonylureas, can cause significant low blood sugar levels (hypoglycemia) in seniors
  • Hypoglycemia can cause dizziness, increased falls, fractures and hospitalisations.
  • If medication is required to manage type 2 diabetes, many safer options exist
  • To see a consumer brochure about deprescribing sulphonylureas, click here, or to see the evidence based deprescribing algorithm for diabetes medications in seniors, click here.

Deprescribing is best done in partnership with a health care provider. There may be reasons why you SHOULD continue taking one of these medications or reasons why you need close supervision while stopping. A variety of resources have been developed to provide further information on these medications and to help patients discuss their options with their health care providers. If you would like further information about the work of the Canadian Deprescribing Network (CaDeN), please contact justin.turner@criugm.qc.ca. If you have specific questions about your medications and health conditions, please contact your doctor or pharmacist.