Table 1 Definitions and examples of initiating, monitoring and stopping therapy

Initiating Therapy

Provides suggestions on which drug to prescribe (or not to prescribe) when a new course of therapy is started.

Examples:

   Prescribe a cholesterol lowering medication for patients with LDL > 130 mg/dL

   Administer influenza vaccination

   Do not prescribe long-acting benzodiazepines for elderly patients

Suggestions may be presented to the physician before choosinga drug (e.g. patient's cholesterol level triggers an alert recommending the use of statins) or after making a prescribing choice(e.g. drug interaction alert may prompt a change in medicine selected).

Monitoring

Provides suggestions for patients on continuing drug therapy (i.e. past the initial prescribing decision).

Examples:

   Increase or decrease dose for patients on existing therapy (e.g. inhaler dose for the prevention of asthma)

   Therapeutic drug monitoring (e.g. laboratory tests to avoid drug toxicity)

   Titration to target (e.g. INR range and warfarin dosing)

Stopping Therapy

Guidance suggesting that a particular medication could be stopped or doses tapered with a view to stopping.

Examples:

   Discontinuation of long-acting benzodiazepines in elderly patients receiving this drug