Unreliable guidance for medication continuation and discontinuation decisions
First to latest report 14 Jul 2016 — 7 Jan 2025
Reports that mention this concern
6
Times this concern has been raised
6
Stated actions linked to this concern
6
What this concern includes
Includes failures of clinical guidance, decision criteria or supporting processes specifically governing whether medication should be continued, paused or discontinued, including guidance on treatment duration, remission-related discontinuation and medication-specific risk considerations.
What is not included
Excludes general medication prescribing, administration, monitoring or supply failures where continuation or discontinuation guidance is not the unsafe condition.
Excludes guidance deficiencies concerning a single named clinical condition or treatment pathway when that condition or pathway provides the more specific supported boundary.
Excludes generic clinical-policy updating, training or evidence-review failures unless they directly impair guidance for medication continuation or discontinuation decisions.
Excludes decisions to continue or discontinue medication that are clinically disputed but not linked to unclear, absent or inconsistently applied guidance.
Trends
Reports over time
Reports mentioning this concern, over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
National Institute for Health and Care Excellence4
NHS England3
Department of Health and Social Care1
Greater Manchester1
Medical Centre1
Medicines and Healthcare products Regulatory Agency1
Royal College of General Practitioners1
Warwick Hospital1
Executive non-departmental public body6
Domiciliary care provider1
Healthcare site1
Health professional body1
Medicines and medical devices regulator1
Ministerial department1
Social-care provider1
Reports and published responses 6 reports
See individual reports that have raised this concern, and the actions taken in response
Gloucestershire
Concerns raised1
Inadequate guidance on persisting with or switching SSRI medication when there is no benefit or adverse side effects
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked responses
National Institute for Health and Care Excellence
Royal College of General Practitioners
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Royal College of General Practitioners
Provide a Mental Health toolkit containing evidence-based guidance on medical and psychological treatments for depression and anxiety.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
National Institute for Health and Care Excellence
Medication side-effect and SSRI safety concerns are best addressed initially by the MHRA, with NICE considering action after collaborative work concludes.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Royal College of General Practitioners
Existing NICE guidance addresses suicide-risk warnings, treatment review and switching antidepressants when SSRIs are ineffective or cause side effects.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Manchester South
Concerns raised1
Lack of national guidance for primary care clinicians on assessing whether to prolong anticoagulation for elderly immobile patients
Linked response
National Institute for Health and Care Excellence
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
National Institute for Health and Care Excellence
Review guidance on stopping and starting VTE prophylaxis to determine whether an update is warranted.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
National Institute for Health and Care Excellence
Existing national guidance addresses discharge VTE risk assessment and prophylaxis decisions, although it does not advise starting prophylaxis de novo in the community.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
Manchester South
Concerns raised1
Lack of clear guidance on discontinuing nilotinib or similar drugs when patients are in remission
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Medicines and Healthcare products Regulatory Agency
NHS England
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
NHS England
The MHRA is considered more appropriate to comment on guidance concerning continued tyrosine kinase inhibitor treatment after remission.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Medicines and Healthcare products Regulatory Agency
Clinical practice issues, including prescribing and treatment decisions, are outside the medicines regulator’s remit.
Outside remitThe respondent said that this matter was outside its role or authority.
Warwickshire
Concerns raised1
Lack of clear guidance for clinicians on pausing DOACs
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Department of Health and Social Care
National Institute for Health and Care Excellence
NHS England
The Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
National Institute for Health and Care Excellence
Further consider the issues raised through guideline surveillance to determine whether the VTE guideline requires updating.
The Trust
Update the Oral Anticoagulant Guideline with a link to the UK Clinical Pharmacy Association perioperative medicines guidance.
The Trust
Further update the Oral Anticoagulant Guideline to provide clearer guidance on DOAC management.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
Department of Health and Social Care
Responsibility for responding to concerns about national DOAC guidance lies with NICE, which develops evidence-based NHS guidelines.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
NHS England
Publishing national clinical guidance on pausing direct oral anticoagulants is outside NHS England’s remit.
Outside remitThe respondent said that this matter was outside its role or authority.
NHS England
NICE is responsible for relevant national guidance on pausing Apixaban and direct oral anticoagulants.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
National Institute for Health and Care Excellence
Guidelines cannot cover all clinical circumstances and do not specifically address pausing direct oral anticoagulants.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
The Trust
National guidance on perioperative DOAC management is available, although the Trust considers its own guidance requires greater clarity.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
Milton Keynes
Concerns raised1
Lack of guidance on when to recommence Warfarin after head injury
Linked response
National Institute for Health and Care Excellence
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
National Institute for Health and Care Excellence
Consider extending the head-injury guideline’s scope to examine evidence and develop recommendations on restarting warfarin during the 2017 update.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
National Institute for Health and Care Excellence
Specific recommendations on restarting Warfarin after head injury cannot be made without extending the guideline’s scope.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
Manchester South
Concerns raised1
Lack of standard directions for managing requests to restart a discontinued medication
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response
NHS England
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
NHS England
Legal responsibility for prescribing lies with the doctor who signs the prescription.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.