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Clinical Notice:Calculations must be re-checked and should not be used alone to guide patient care, nor should they substitute for professional clinical judgment. OpiCalc is an auxiliary reference tool for qualified healthcare professionals.

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Recent Journal Updates

British J Clinical PharmacologyMay 1, 2026
A scoping review of quality prescribing indicators, rules and criteria for primary care

Clinical Context

We think this might be relevant to the clinical guidance for STOPPSTART Criteria.

DiabetologiaMay 1, 2026
Psychosocial implications, acceptability and ethics of screening for paediatric type 1 diabetes: a systematic review and mixed methods evidence synthesis

Clinical Context

We think this might be relevant to the clinical guidance for STOPPSTART Criteria.

Drug SafetyApr 17, 2026
Risk of Fetal Exposure to Teratogenic Medications: Development of Evidence for the Teratogenic Risk Impact and Mitigation (TRIM) Tool

Clinical Context

We think this might be relevant to the clinical guidance for STOPPSTART Criteria.

STOPP/START Criteria

STOPP/START is a reference tool, not a calculator. It lists Potentially Inappropriate Medications (STOPP) to deprescribe, and omission of evidence-based therapies (START) to initiate.
Cardiovascular

Loop diuretic for dependent ankle oedema only i.e. no clinical signs of heart failure (no evidence of efficacy, compression hosiery more appropriate).

Cardiovascular

Thiazide diuretic with a history of gout (may exacerbate gout).

Cardiovascular

Beta-blocker in combination with verapamil (risk of symptomatic heart block).

CNS & Psych

TCAs (Tricyclic Antidepressants) with dementia, narrow angle glaucoma, cardiac conduction abnormalities, prostatism, or prior history of urinary retention (risk of worsening these conditions).

CNS & Psych

Benzodiazepines for ≥ 4 weeks (risk of prolonged sedation, confusion, impaired balance, falls).

CNS & Psych

Antipsychotics in patients with behavioural and psychological symptoms of dementia (BPSD) unless symptoms are severe and other non-pharmacological treatments have failed.

Gastrointestinal

PPIs for uncomplicated peptic ulcer disease or erosive peptic oesophagitis at full therapeutic dosage for > 8 weeks (dose reduction or earlier discontinuation indicated).

Respiratory

Theophylline as monotherapy for COPD (safer, more effective alternative inhaled bronchodilators available).

Musculoskeletal

NSAIDs with a history of peptic ulcer disease or gastrointestinal bleeding, unless with concurrent PPI or H2 antagonist.

Musculoskeletal

Long-term NSAIDs (>3 months) for relief of mild osteoarthritis pain (paracetamol preferred).

Falls

Benzodiazepines, neuroleptics, vasodilator drugs (e.g. alpha-1 blockers, calcium channel blockers, long-acting nitrates, ACEI, ARBs) in patients with a history of recurrent falls.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

When to Use

Comprehensive medication review in older adults (≥ 65 years).
Investigating adverse drug events, falls, cognitive decline, or unexplained functional deterioration.
Routine deprescribing in polypharmacy (≥ 5 medications).
Identifying omissions of evidence-based therapies (START).

Dual Action

Unlike the Beers Criteria which primarily focuses on what to stop (Potentially Inappropriate Medications), the STOPP/START criteria is unique because it also contains a START section: identifying medications that are missing but clinically indicated in older adults.

Related Scores in Practice

In clinical practice, this assessment is frequently evaluated alongside other validated measures. Depending on the patient's presentation and specific diagnostic requirements, you may also need to utilize the Beers Criteria (PIMs) to formulate a comprehensive care plan.

Last Comprehensive Review: 2026

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SPMSQ
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