Table 1

How to determine drug utility

What is the strength of indication (in order of decreasing utility)?
The drug:
1.Provides immediate relief of distressing symptoms (eg, analgesics, antiemetics and antipruritics).
2.Effectively modifies an acute condition that is life threatening or will soon result in distressing symptoms if not treated (eg, antibiotics for sepsis, diuretics for acute heart failure and bronchodilators for asthma).
3.Effectively modifies a chronic condition that might progress to become life threatening or cause distressing symptoms if not treated (eg, methotrexate for rheumatoid arthritis and ACE inhibitors for chronic heart failure).
4.Has the potential to prevent serious diseases or adverse events in the future, without immediate effect (eg, antiplatelet agents to prevent cardiovascular disease, bisphosphonates to prevent osteoporotic fractures and antihypertensives to prevent stroke).
5.Is unlikely to be useful in either the short or long term (eg, vitamin supplements).
6.Is prescribed where a non-drug therapy (eg, physiotherapy instead of non-steroidal anti-inflammatory drugs for lower back pain) is more beneficial.
What is the likelihood of misuse, toxicity or non-adherence?
The drug:
1.Is associated with little benefit and high risk of toxicity in most older patients (on the basis of Beers’ criteria or other drugs-to-avoid lists).
2.Is a duplication in drug therapy (ie, a second drug from the same class).
3.Is prescribed for an adverse drug reaction (ADR).
 If so, can the drug causing the ADR be withdrawn or substituted with another agent less likely to cause an ADR?
4.Is a potentially beneficial drug but is prescribed at a dose likely to cause toxicity.
 If so, can another effective, less toxic dose or medication be substituted?
5.Has the potential for significant drug–drug or drug–disease interactions.
 If so, can it be withdrawn or substituted with another agent less likely to cause an interaction?
6.Is taken more often than once daily.
 Can another equally effective drug be substituted that can be scheduled once daily?
7.Can be safely administered as a combination medication.
8.Is causing significant difficulties with adherence?
 If so, can it be withdrawn or substituted with another agent more likely to be taken?