Surfaces additive anticholinergic, sedative, hypotension, constipation, hypoglycemia, and selected cardiac-electrical signals.
GlobalRPh structured medication-review support
Comprehensive Medication Burden and Deprescribing Review Analyzer
Turns a complete medication list into a prioritized, transparent review of cumulative burden, selected high-consequence combinations, duplicate therapy, renal considerations, reconciliation gaps, and clinician-directed discussion points.
Medication-list entry
Enter the complete current medication list
Include prescriptions, nonprescription products, inhalers, eye drops, injections, vitamins, supplements, patches, and as-needed therapies whenever possible. One product per line is preferred.
Do not enter a patient name, date of birth, medical-record number, address, or other direct identifier. The PHP version processes the submitted list in memory and does not intentionally store it, but server and security logs still require administrative review.
Structured review report
Analysis results
Your report will appear here.After analysis, the page moves directly to this section and focuses the result heading. Charts summarize signals without creating an overall risk score.
Fundamental purpose
Find the medication-list questions that deserve human review first
Medication-related harm often reflects cumulative exposure, interacting mechanisms, duplicate ingredients, changing organ function, or therapies that continued after the original purpose changed. The analyzer keeps unlike domains separate rather than hiding them inside an unvalidated total.
This is not a prescribing, interaction-checking, or deprescribing decision engine. It does not know the complete diagnosis, response, dose exposure, duration, laboratory trend, ECG, adherence, goals of care, or whether a high-risk combination is intentionally justified.
Prioritizes selected high-consequence patterns such as opioid/CNS depressants, antithrombotics/NSAIDs, renal-risk triads, and nitrate/PDE-5 exposure.
Separates recognized lines from active ingredients, preserves unknown entries, and identifies missing schedules and indications.
Generates medication-specific prompts about indication, benefit, duration, monitoring, adverse effects, and planned discontinuation.
Operational model
How the analyzer processes a medication list
The calculation is deterministic and local to this package. The same curated data and review logic are supplied in the JavaScript and PHP releases.
Case, punctuation, and common brand spelling are normalized.
Generic aliases and explicit combination-brand maps identify one or more active ingredients.
Each ingredient receives transparent domain indicators, tags, renal prompts, and discussion metadata.
Optional age, kidney function, symptoms, and disease-state flags change review priority rather than medication scoring.
Findings are sorted high, moderate, and informational without producing a composite risk score.
Transparent indicators
What the displayed numbers and charts mean
The numbers improve consistency and scanability. They are not validated patient-specific probabilities and do not replace dose-, route-, duration-, or exposure-based assessment.
Anticholinergic screening burden
Σ medication AC indicator (0–3)A total of 3 or more triggers review. Published scales can disagree, and this is not a complete ACB, ARS, ADS, or DBI implementation.
Sedative burden indicator
Σ medication sedation indicator (0–3)A total of 4 or more triggers review. Dose, timing, tolerance, alcohol, kidney function, and respiratory status can materially change actual exposure.
Hypotension/orthostasis indicator
Σ BP-lowering/orthostasis indicator (0–3)The engine considers both the sum and medication count, then raises priority when low blood pressure, syncope, dizziness, or falls are marked.
Contributor count
distinct ingredients with a nonzero domain indicatorThe new contributor chart distinguishes one high-indicator medication from several medications contributing smaller signals.
Input completeness
recognition, schedule, and indication percentagesCompleteness is displayed because unrecognized products and missing use details can materially limit interpretation.
Finding priority mix
high → moderate → informationPriority reflects predefined review logic and context, not certainty that harm is occurring or that a medication should be changed.
Evidence context
Why the report supports review rather than automatic deprescribing
Medication-appropriateness criteria and burden measures can organize a review, but the decision to continue, taper, substitute, or stop therapy remains patient-specific and requires indication, benefit, harm, goals, and monitoring data.
Explicit criteria are broader than this tool
The 2023 AGS Beers Criteria and STOPP/START version 3 address potentially inappropriate prescribing in older adults. This analyzer is informed by similar review principles but is not represented as a complete implementation of either framework.
Burden measures are not interchangeable
A 2024 systematic review found that higher Drug Burden Index exposure may be associated with falls and poorer function or cognition, while results varied across studies and outcomes. The analyzer therefore labels its AC and sedation values as screening indicators rather than DBI values.
Deprescribing evidence is clinically useful but mixed
A 2026 pharmacist-led deprescribing meta-analysis reported improvements in medication-burden indices without increased adverse events, while pooled medication-count and hard-outcome effects remained uncertain.
Process and follow-up matter
Recent randomized evidence reinforces shared decision-making, pharmacist-prescriber collaboration, patient preferences, and follow-up. More medications can be deprescribed without guaranteeing short-term improvement in quality of life or total health problems.
Version 1.5 evidence positioning: the medication inventory and rule assignments remain unchanged from Version 1.4. The update improves navigation, input completeness, result prioritization, visualization, accessibility, and evidence explanation.
Selected evidence references used for this release
- American Geriatrics Society 2023 Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372. PMID: 37139824.
- O'Mahony D, Cherubini A, Renom Guiteras A, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023. PMID: 37256475.
- Liu BM, Kouladjian O'Donnell L, Gnjidic D, et al. Association of the Drug Burden Index exposure with outcomes: a systematic review. J Am Geriatr Soc. 2024;72(2):589-603. doi:10.1111/jgs.18691. PMID: 38006299.
- Tesfaye ZT, Horsa BA, Yismaw MB. Impact of pharmacist-led deprescribing interventions on medication related outcomes among older adults: a systematic review and meta-analysis. BMC Geriatr. 2026;26:181. doi:10.1186/s12877-025-06964-9. PMID: 41514446.
- Baas G, et al. Cluster-randomized primary-care deprescribing trial in older adults with polypharmacy. Age Ageing. 2026;55(7):afag209. doi:10.1093/ageing/afag209. PMID: 42472621.
Background and limitations
How to interpret the report safely
The analyzer is designed to make medication review more structured, reproducible, and discussion-ready. It intentionally stops before making a patient-specific treatment decision.
Why there is no single overall medication-risk score
Anticholinergic exposure, sedation, orthostasis, bleeding, kidney risk, hypoglycemia, QT concerns, and duplicate therapy represent different mechanisms and outcomes. Adding them into one number would falsely imply equivalence and clinical validation.
How anticholinergic and sedative assignments are used
The local table applies transparent 0–3 indicators. Published scales can assign different values to the same medication. Dose, route, timing, active metabolites, tolerance, kidney/liver function, and actual use frequency are not converted into exposure-equivalent units.
What the renal section does and does not do
Renal tags trigger label-review prompts such as below-60, below-45, below-30, creatinine-clearance-specific, potassium-monitoring, or nephrotoxicity review. The calculator does not convert eGFR to CrCl, estimate dialysis clearance, select a dose, or override indication-specific labeling.
What “deprescribing discussion point” means
A discussion point asks whether the indication remains active, benefit is measurable, duration is still appropriate, monitoring is complete, adverse effects could be medication-related, and patient goals have changed. It is not an instruction to stop, taper, substitute, or withhold therapy.
Database coverage and maintenance
Version 1.5.0 includes 408 generic records, 930 generic/brand aliases, and 54 explicit combination-brand maps. Coverage remains finite. Newly marketed drugs, uncommon products, compounded preparations, spelling variations, and some biologics may remain unrecognized.
Important exclusions
- No comprehensive commercial drug-interaction database.
- No dose equivalence, adherence, pharmacogenomic, hepatic, pregnancy, dialysis, allergy, or emergency-triage model.
- No full Beers, STOPP/START, ACB, ARS, ADS, DBI, QT, or serotonin-syndrome implementation.
- No diagnosis, taper schedule, substitute selection, stop order, or prescribing order.
Production governance: a qualified pharmacist or physician should review every data release, selected interaction rule, renal statement, and source note before public deployment and after every medication-data revision.