US Pharm. 2017;42(6):13-14.

Using Five or More Medications Daily

As people age, the risk for developing chronic health conditions becomes more common. A consequence of managing multiple chronic health conditions is the daily use of several different medications. These days, older Americans often see multiple physicians, each prescribing something new or changing dosages, which only increases the complexity of an already-challenging situation. Although no concrete definition of the term exists, polypharmacy has come to mean the use of several (usually five or more) medications on a daily basis, with the possibility that these may not all be clinically necessary. The consequences of polypharmacy can be dangerous and can include adverse drug reactions and unintentional overdose.

Polypharmacy Is Common—and Potentially Dangerous

A complex medical system creates polypharmacy, in which older patients with multiple chronic conditions take several different medications with various dosages, prescribed by many separate physicians and perhaps filled at more than one pharmacy.

Age Is a Contributing Factor

In the United States, people over age 65 years make up 13% of the population, but they use 30% of all prescription medications. In fact, recent studies have shown that the percentage of people in this age group taking five or more medications or supplements increased from 53.4% to 67.1% between 2006 and 2011. When managing several chronic conditions, such as high blood pressure and heart failure, the use of multiple medications is often clinically necessary. Polypharmacy becomes problematic when the reason for the medication is unclear, when medication is taken to treat side effects of other drugs, when dosing and timing are complicated, and when medications interact with each other.

Adverse Reactions Can Lead to Hospitalization and Even Death

Polypharmacy increases the risk of adverse reactions to medications. The more drugs, the higher the risk of drug interactions. Research has shown that patients taking five to nine medications have a 50% chance of an adverse drug interaction, increasing to 100% when they are taking 20 or more medications. Health Research Funding reports that polypharmacy accounts for almost 30% of all hospital admissions and is the fifth leading cause of death in the U.S.

Medications are only effective in treating a disease when taken as prescribed. Patients who are taking several different medications may forget to take all of them, take them at the wrong time, or take them too often. As a result, the condition can worsen, treatment can fail, drug reactions can occur, and patients can become hospitalized—all of which are potentially life-threatening situations.

What Patients and Caregivers Can Do

Patients and caregivers can look for common symptoms of adverse reactions and drug interactions resulting from polypharmacy. The common signs are a loss of appetite, diarrhea, tiredness or reduced alertness, confusion and hallucinations, falls, weakness and dizziness, skin rashes, depression, anxiety, and excitability. Unfortunately, these signs and symptoms can also be related to the disease itself or be a consequence of aging.

Also, be aware of the medications most commonly associated with adverse effects and drug interactions. The most frequently prescribed medications are nonsteroidal anti-inflammatory drugs (NSAIDs, like ibuprofen), blood pressure medications, antibiotics, and medications used to treat depression.

The most important measure that patients can take to prevent polypharmacy is to ensure that all of their healthcare providers have a complete and up-to-date list of their medications, including dosages and when they should be taken. This list should include OTC medications, supplements, and vitamins. It is excellent practice for patients to carry a list of their medications, updating it whenever there is a change.

Your pharmacist can help! Before buying any OTC product or supplement, be sure to ask your pharmacist if it is safe to take with other medications or with your medical condition. Pharmacists can speak with your physician directly to better understand why a medication is prescribed and to discuss alternate therapies with a lower risk of drug interactions A complex medical system creates polypharmacy, in which older patients with multiple chronic conditions take several different medications with various dosages, prescribed by many separate physicians and perhaps filled at more than one pharmacy.

To comment on this article, contact rdavidson@uspharmacist.com.