Deprescribing or represcribing: not just a semantic dilemma.

Older people consume medicines in large quantities and many initiatives aim at reducing this drug load often called polypharmacy in this population. Given the fact that polypharmacy often leads to inappropriate prescribing and drug related problems, various instruments have been developed to identify potentially inappropriate medications (PIM), such as the well-known and frequently updated Beers list or other negative lists (e.g., STOPP, Hong Kong-specific criteria. They indicate what an older person should NOT be prescribed or should be stopped if already prescribed. Consequently, such PIM lists should support the approach that became famous as “deprescribing”. This term has gained such popularity that it appears as a fashionable catchword to mark one of the most important areas of geriatric medicine. The recent Athens EuGMS congress (October 11–13, 2021) addressed deprescribing in several lectures. The older and also these very recent findings on clinical impact of listing approaches underline that deprescribing is only half the story—we should really start thinking a more appropriate novel term to cover the entire story, namely represcribing—appropriate drugs in, inappropriate drugs out. Clearly, in a patient on 25 medications, detoxification (inappropriate drugs out) would presumably be prevalent, but in average older people seem to have as many inappropriate drugs as they are missing the appropriate ones. To better cope with these two sides of the coin, represcribing might be considered as the new catchword, that is “desprescribing 2.0” if you wish. The new catchword should facilitate ambitions to scientifically and clinically address both the main aspects of drug treatment for the sake of older patients- over- and undertreatment.