Gradual Dose Reduction

Psychotropic Medication Reductions Overview

The goal of Medical Management Services ensure homes are compliant with all CMS and State guidelines regarding psychotropic medications and gradual dose reductions.

Overmedicating can cause the following problems:

  • Increased Fall Risk
  • Memory Impairment
  • Functional Decline
  • Withdrawal; Sedation (Chemical Restraint)
  • Movement Disorders; Gait Disturbance
  • Orthostatic/Postural Hypertension
  • Agitation
  • Poly Pharmacy Problems

In addition, overmedicating can cause homes to receive F-Tags related to drug use.

  • F-309 – Necessary Care for Highest Practicable Well Being – 42 CFR 483.25
  • F-222 – Right to be free from chemical restraints – 42 CFR 483.13(a)
  • F-329 – Free from Unnecessary Drugs – 42 CFR 483.25(l)(2)(i, ii)5

Federal law requires that “each resident’s drug regimen must be free from unnecessary drugs.” According to federal regulations, an unnecessary drug is any drug used:

  • In excessive dosage, including duplicate drug therapy;
  • For excessive duration;
  • Without adequate monitoring;
  • Without adequate indications for its use;
  • In the presence of adverse consequences which indicate that use of the drug should be reduced or discontinued; or
  • Any combination of the reasons above

Commonly over used Psychotropic Medications

Antidepressant Medications Anxiolytic Medications
Imipramine (Tofranil) (counteract or diminish anxiety)
Desipramine (Norpramin) Oxazepam (Serax)
Doxepin (Adapin, Sinequan) Alprazolam (Xanax)
Nortiptyline (Aventyl, Pamelor) Diazepam (Valium)
Fluoxetine (Prozac) Lorazepam (Ativan)
Sertraline (Zoloft) Diphenhydramine (Benadryl)
Trazodone (Desyrel) Hydroxyzine (Atarax, Vistaril)
Buspirone (BuSpar)

Antipsychotic Medications
Haloperidol (Haldol) Sedative-Hypnotic Medications
Thioridazine (Mellaril) (sleep inducers)
Thiothixene (Navane) Flurazepam (Dalmane)
Chlorpromazine (Thorazine) Temazepam (Restoril)
Risperidone (Risperdal) Lorazepam (Ativan)
Olanzapine (Zyprexa) Oxazepam (Serax)
Quetiapine (Seroquel) Diphenhydramie (Benadryl)
Hydroxyzine (Atarax, Vistaril)
Mood Stabilizers Chloral hydrate (several brands)
Lithium carbonate (several brands)
Valproic acid (Depakene)