• Do not automatically raise drug doses or add new drugs to a regimen for a "refractory" disorder without strongly considering that the problem stems from nonadherence.
Taken together, these and 10 other principles "represent a shift in prescribing paradigm from 'newer and more [are] better' to 'fewer and more time-tested [are] best,' " Dr. Schiff and his colleagues concluded.
"While clinicians must always weigh the benefits of conservative prescribing against the risks of withholding potentially needed medications, at the very least we should seek to shift the burden of proof toward demanding a higher standard of evidence of benefit before exposing patients to the risks of drugs," they said.
This work was supported in part by the FLIP (Formulary Leveraged Improved Prescribing) project and a grant from the Agency for Healthcare Research and Quality. Dr. Schiff’s associate, Bruce L. Lambert, Ph.D., reported ties to Abbott Laboratories, Transcept Pharmaceuticals, Pharm I.R., Novartis, and Ortho McNeil.