Medication reviews

Note: Regular medication reviews are important for people with developmental disability.

A thorough medication review aims to maximise a person’s benefit from their medication regimen, and minimise medicine-related problems. The importance of regular medication reviews is heightened in people with developmental disability because:

  • polypharmacy is common—often with multiple psychoactive drugs (eg antipsychotics, anticonvulsants) and off-label medications
  • preparations may be inappropriately altered by carers or support people (eg tablets crushed when they should be taken whole)
  • the person may be unable to communicate adverse effects
  • rationale for prescribing medication is often unclear (eg history may be difficult to obtain, inadequate documentation in health record)
  • overall pill burden can contribute to dysphagia
  • some drugs may no longer be required
  • more effective drugs may be available, with less adverse effects
  • the dose may not be appropriate (often dosages are unnecessarily high)
  • the route of drug administration may not be appropriate (eg intramuscular administration prescribed, but the person is capable of taking drugs orally).

Medication reviews can help to establish rationale for medications and identify potential changes to medication regimes (eg reducing pill burden through combination drugs and deprescribing, adjusting doses or route of administration, enabling provision of medication-related information).

Medicare rebates may apply for annual referrals to a community pharmacy or accredited pharmacist for Domiciliary Medication Management Review (DMMR).

The medication review should include assessment of complementary and alternative therapies, over-the-counter medicines and dietary supplements.

Note: A medication review should include assessment of complementary and alternative therapies, over-the-counter medicines and supplements.

Clearly record the rationale for all medications in the person’s health record. If a clear indication for the drug cannot be found, cautious withdrawal should be considered. For advice, see:

Patients and their support people should be informed about the drugs prescribed, including their reasons for use and potential adverse effects. Discuss the potential manifestations of adverse effects in people who have difficulty communicating (eg indirect signs that may indicate nausea). Consider the use of communication aids and strategies to establish successful communication and enable assessment of medication effects.