Still Taking That Medicine? Why Your Prescriptions Deserve an MOT Too

A prescription can begin during illness, pain or sleeplessness, or when a long-term condition is first diagnosed. Years later, your health and priorities may have changed. The original decision may have been right; the question is whether it still fits today.

This matters at any age, especially when several conditions and treatments overlap. A medicine may help, cause a side effect, interact with something new or be difficult to take. The right outcome might be to continue, adjust, monitor or make a supervised change. A medicine review is one part of the wider health picture; for a broader reflection, see How Well Are You Really Ageing?

What is a medication review?

NICE describes a structured medication review as a critical examination of a person’s medicines, intended to agree treatment with them, optimise its impact, minimise medicine-related problems and reduce waste. NICE says to consider one when there is a clear purpose, including for people taking multiple medicines, living with long-term conditions, or older adults. A pharmacist or another suitably skilled health professional may lead it.

The emphasis is on shared and person-centred. A review should take your views and concerns seriously, considering all medicines you use—prescribed, over the counter or complementary—alongside effectiveness, safety, side effects and monitoring. Read the NICE medicines optimisation recommendations for the formal definition and scope.

This is broader than checking whether a repeat prescription is due. It makes the treatment plan clear again: what each item is for, what you notice it doing and what the next decision should be. It may take more than one conversation.

A review is not a promise that you will take fewer medicines. Its purpose is an informed plan that fits your circumstances, not a target number of tablets or a guaranteed health benefit.

When might it be worth asking?

Ask your GP practice or pharmacist about a review if your medicine list has grown, you are unsure what something is for, your routine is hard to manage, you notice a side effect or your health has changed. A recent hospital stay is another useful prompt.

Mention difficulty swallowing or opening packaging, dizziness or falls, missed doses, supply problems, or a new medicine or supplement. These details help a clinician assess the whole picture; they do not prove a medicine is responsible.

Bring a current list or packets, including inhalers, creams, painkillers, vitamins, herbal products and occasional medicines. Describe how you actually take them. You can invite someone who helps organise your medicines.

How to make the conversation useful

Start with what matters in your life

Before the appointment, write down one or two priorities: perhaps staying alert, avoiding a side effect, making treatment manageable while travelling, or understanding why a medicine is still needed. Explain what a good outcome would look like to you.

Ask about each medicine, not just the list as a whole

Ask what each item treats or prevents, what benefit to expect, what the possible downsides are and whether monitoring is needed. If it changes, what should you look out for and whom should you contact?

Ask how certain the answer is and whether there are alternatives, including no change. For preventive medicines, ask about benefits and harms for your circumstances rather than relying on averages.

Leave with a written next step

Before you leave, check what is staying the same, what is changing, who is making the change and when. Ask whether follow-up or monitoring is needed. Request an updated list and a contact route; it is fine to arrange more time if the decision is not clear.

Deprescribing is planned care, not self-discontinuation

Deprescribing means reducing or stopping a medicine when an agreed clinical assessment finds that appropriate. It is one possible result, not the purpose of a review. Continuing may be right; stopping may bring back the condition or cause withdrawal effects. The balance is individual.

Benzodiazepines and Z-drugs, sometimes prescribed for anxiety or sleep, can lead to dependence and withdrawal symptoms with ongoing use. Dependence is not a judgement about character and does not by itself mean addiction. These medicines can also cause drowsiness and affect balance, potentially contributing to falls, and may affect cognition. Alcohol and other sedating medicines can increase impairment or interact. If memory is a concern, it can help to consider the wider picture too; read about brain health and vascular risk. Ask the prescriber to review your situation. NICE’s guideline on medicines associated with dependence or withdrawal symptoms covers shared decisions, dose reduction and support. Any change should be gradual when appropriate and clinician-guided; there is no one schedule for everyone.

Never abruptly stop or reduce a benzodiazepine or Z-drug, or make an unsupervised change, on the basis of this article. Contact the prescriber or another appropriate clinician to agree the safest next step. The same caution applies to other prescribed treatments: a medicine’s place on an online list does not establish what is right for you.

If symptoms appear after a change, note when they began and contact the clinician if concerned. Seek urgent care for severe symptoms; a plan should say whom to contact and what happens next.

Two familiar examples where context matters

Aspirin: first-event prevention is not the same as secondary prevention

Primary prevention means trying to prevent a first cardiovascular event. NICE says do not routinely offer aspirin for primary prevention; this recommendation was added in January 2023. Aspirin is not generally “bad”: secondary prevention after established cardiovascular disease is a different clinical decision. Following a heart attack, stroke or selected procedures, antiplatelet treatment may be part of an individual care plan. NICE’s acute coronary syndromes guidance (NG185) covers care after acute coronary events.

Aspirin reduces clotting but can increase bleeding risk, so the balance depends on why it was prescribed and on your health. The NICE cardiovascular prevention guidance (NG238) advises against routinely offering it to prevent a first CVD event. Do not stop daily aspirin because of an internet article. If you take it, especially after a heart attack, stroke, established CVD or a procedure, ask your GP, pharmacist or responsible clinician before any change.

Antibiotics: not for viruses, but sometimes necessary

Antibiotics treat or prevent some bacterial infections, not viruses such as colds and flu. When indicated for a serious bacterial infection, they can be lifesaving. For uncomplicated acute cough or bronchitis, however, antibiotics are not routinely needed; NICE says clinicians may use a no-antibiotic or delayed/back-up prescription approach depending on risk and assessment. See NICE guidance on acute cough, including bronchitis (NG120) and the NHS antibiotics guidance.

Antibiotics can cause side effects, and unnecessary use contributes to antimicrobial resistance. This is not a reason to refuse treatment a clinician considers indicated, borrow someone else’s supply or alter a prescribed course without advice. Ask the prescriber or pharmacist about side effects, missed doses or concerns. NICE’s antimicrobial stewardship guidance supports effective use that helps preserve these medicines.

Four claims worth checking

CLAIM: “A medication review is just a repeat-prescription check.”

CHECK: NICE defines structured review as a critical, shared examination of the person’s medicines, concerns, safety, effectiveness and monitoring. It is more than authorising another supply.

CLAIM: “If I have taken a sleeping tablet for years, I can stop tonight.”

CHECK: Ongoing benzodiazepine or Z-drug use can involve dependence and withdrawal. Drowsiness, impaired balance, falls, cognitive effects and interactions also deserve review. NICE supports shared, clinician-guided decisions; do not abruptly stop or change these medicines alone.

CLAIM: “If aspirin is not routinely offered to prevent a first heart attack, everyone taking it should stop.”

CHECK: NICE advises against routinely offering aspirin for primary prevention, but secondary prevention after established CVD, MI, stroke or selected procedures is a different decision. Bleeding risk matters. Never stop daily aspirin on this article’s say-so; discuss it with your clinician.

CLAIM: “Antibiotics are either unnecessary for coughs or dangerous to take.”

CHECK: Antibiotics do not treat viruses and may be used selectively, including delayed prescriptions for some uncomplicated illness, but they can be lifesaving when indicated for bacterial infection. Side effects and resistance matter; follow clinical advice rather than refusing or changing prescribed treatment alone.

Give your medicine cabinet an MOT

Gather the packets or an up-to-date list, including over-the-counter medicines and supplements. Ask yourself these eight questions and take the answers to your GP or pharmacist. For help separating evidence from supplement marketing, see our guide to longevity supplement evidence.

1. What is each medicine for?
2. Is it still needed?
3. Is the dose still appropriate?
4. Could it interact with my other medicines or alcohol?
5. Has guidance changed since I started it?
6. Have I included my over-the-counter medicines, vitamins, herbal products and supplements?
7. If it is changed, what should I expect and who should I contact?
8. What monitoring or follow-up do I need?

You are allowed to ask questions without feeling ungrateful or difficult. A medication review is not a referendum on past care; it is a chance to make the next decision with the best information available.

Evidence has limits: guidance supports a structured, shared approach but does not guarantee a particular outcome from every review. This article does not quantify benefits or set an individual withdrawal schedule. Your clinician must apply current guidance to your diagnosis and circumstances.

Sources / Further reading

• NICE: Medicines optimisation (NG5). Structured medication review, shared decisions and information to consider.
• NICE: Medicines associated with dependence or withdrawal symptoms (NG215). General principles for reviewing and withdrawing medicines, including benzodiazepines and Z-drugs.
• NICE: Cardiovascular disease risk assessment and reduction (NG238). Includes the recommendation not to routinely offer aspirin for primary prevention.
• NICE: Acute coronary syndromes (NG185). Guidance relevant to treatment after acute coronary events.
• NICE: Cough (acute): antimicrobial prescribing (NG120). Selective antibiotic prescribing for acute cough, including bronchitis.
• NHS: Antibiotics. What antibiotics treat and how to seek advice about taking them.
• NICE: Antimicrobial stewardship (NG15). Effective use of antimicrobials and preserving their effectiveness.
• NHS England: Structured medication reviews and medicines optimisation guidance (17 September 2020). Service implementation guidance; operational detail may be dated.