[Why represcribing instead of deprescribing?]

Demographic change is leading to an ever-increasing prevalence of multimorbidity and polypharmacy. At the same time, older people are excluded from randomized controlled approval studies. Due to this age-blind approach, there is a lack of evidence regarding the efficacy, safety, and suitability for older people of many drugs used by the main consumers of medicinal products. To solve this problem, many different list approaches and tools have been developed, often using a combination of existing evidence and expert opinion.

A narrative evaluation of deprescribing and represcribing was conducted based on current literature.

Most of the tools developed focus on discontinuing potentially inappropriate medication (PIM; i.e., deprescribing) and disregard the patient's clinical condition and the need for useful age-appropriate medication or potentially omitted medication (POM). Represcribing is a further development that encompasses both the deprescribing of PIMs and the prescribing of POMs that are useful and safe for older people. Clinical validation of available tools in a few randomized controlled trials with relevant clinical endpoints, such as the occurrence of adverse drug reactions, suggests that represcribing is more feasible and successful than deprescribing.

The goal of age-appropriate drug therapy in geriatric patients should not only be to reduce the number of medications or eliminate polypharmacy, but also to transition from poor polypharmacy to good polypharmacy through individualization and represcribing.