American Society of Health-System Pharmacists

View all recommendations from this society

June 1, 2017; updated July 28, 2021

Do not initiate medications to treat symptoms without determining if symptoms are due to an existing therapy causing side effects, adverse events, medication interactions, or lack of adherence and whether a dosage adjustment, discontinuation of a medication, or another medication is warranted.

Medications are often prescribed to treat symptoms that are really side effects of other medications without determining if the pre-existing medication is truly needed or could be discontinued. New medications should not be initiated without taking into consideration patient adherence with their pre-existing medication and whether their current dose is effective at controlling/treating symptoms. Incorporating Comprehensive Medication Management (CMM) services can assist in meeting the recommendations. CMM is a patient care service where medication-use experts collaborate with patients, their healthcare team, families, and caregivers to review and ensure treatment plans are optimal, with respect to patients’ beliefs, values, autonomy, and agency.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

A task force made up of pharmacists from all practice settings was formed. The task force was oriented to the criteria used to establish Choosing Wisely lists and already established recommendations. Based on this information and on their knowledge of how medications are prescribed, dispensed, and administered, the task force developed an initial list of recommendations. Over time this list was vetted, evaluated, researched, and referenced. Through a consensus process over time the list was prioritized down to a total of five recommendations. This list was approved by the ASHP Board of Directors.


Schiff GD, et al. Promoting more conservative prescribing. JAMA 2009;301:865-7.

Schiff GD, et al. Principles of conservative prescribing. Arch Intern Med. 2011;171:1433-40.

Shane, R and Abramowitz, PW. Choosing Wisely: Pharmacy’s role in effective use of medications. Am J Health-Syst Pharm. 2015; 72:1529-30.

The Patient Care Process for delivering Comprehensive Medication Management (CMM): Optimizing Medication Use in Patient-Centered, Team-Based Care Settings. CMM in Primary Care Research Team. July 2018. Available at

ASHP Practice Advancement Initiative 2030: New recommendations for advancing pharmacy practice in health systems. Am J Health-Sys Pharm. 2020; 77:113-122.