Polypharmacy

Polypharmacy is when you regularly take multiple medications. There’s no defining number that experts all agree on. But most experts set the minimum at either four or five medicines.

Polypharmacy is much more likely if you have multiple chronic health conditions. That’s because you might need to take several medicines. Some of the most common conditions include high blood pressure, high cholesterol and diabetes. But supplements, herbal products and over-the-counter drugs can also be part of polypharmacy.

Taking multiple medicines regularly is common, especially as you get older. For older adults (over 65) in the U.S., about 2 out of 5 take at least five medicines regularly. And about 1 in 5 take 10 or more medicines regularly.

Is polypharmacy good or bad?

It can be either. When polypharmacy is done safely and well, it’s called “appropriate polypharmacy.” Appropriate polypharmacy means you:

• Take the lowest number of medicines possible
• Take the right medicines for your needs, and they’re all effective
• Don’t have any trouble taking your medicines as prescribed
• Have no side effects, or can manage the ones you have
• Don’t have any harmful reactions from your medicines
• Don’t have harmful interactions between your medicines or your other health conditions
• Review your medicines regularly with your healthcare provider(s)
• Check with your provider before you start regularly taking herbs, supplements or over-the-counter medicines
• Can work with your providers to change or stop medicines as needed

But polypharmacy stops being a good thing if any of the above aren’t true. It’s also not a good thing if you have an increased risk for side effects or harmful reactions. When polypharmacy isn’t a good thing, it’s known as “inappropriate polypharmacy.”

Why preventing inappropriate polypharmacy is important

Inappropriate polypharmacy can lead to or contribute to serious complications and lower your quality of life. Some of the ways it does that include:

• Adverse drug events: The more medicines you take, the more likely these are to happen. Examples include extremely low or high blood pressure, bleeding or confusion.
• Decreased independence: Memory loss, decreased strength and balance issues can all happen because of polypharmacy. And they can keep you from managing your activities of daily living.
• Delirium: Inappropriate polypharmacy is a key contributor to delirium. That’s a brain-disrupting condition that affects thinking, memory and behavior.
• Dementia: Taking too many medicines is a known factor for developing dementia.
• Frailty: Polypharmacy can affect your body’s ability to recover from illnesses or injuries.
• Increased fall risk: Many chronic disease medications affect your balance and strength. That’s why fall-related injuries are among the most dangerous effects of polypharmacy.
• Overmedication: Polypharmacy can lead to medication effects that are too strong. That can lead to severe side effects or toxic effects.

Inappropriate polypharmacy and its complications all increase your risk of early death, too.

What causes polypharmacy?

Polypharmacy usually happens because of a combination of factors. Some examples include:

• Having several chronic conditions: Many chronic conditions raise your risk of developing other chronic illnesses. And the more chronic conditions you have, the more likely you are to need multiple medicines.
• Lack of communication between providers: This is especially true for specialists. They focus on specific body systems. That can lead to disconnects in care.
• Not having a primary care provider: It’s easier for gaps to happen when you don’t have a primary care provider. They look at the big picture of your health and work with your specialists to make your care as seamless as possible.
• Prescribing cascades: These are like domino effects. They start when your provider adds new medicines to help with side effects from medicines you already take.
• Trouble taking your medicines as prescribed: Polypharmacy effects can make it harder to take your medicines as prescribed. Examples include trouble reading or opening pill bottles, understanding the instructions or forgetting to take your medicines.
• Lack of information: Providers may prescribe the wrong medicines if they don’t know what you take or don’t have your complete health record.

Most of these factors don’t automatically make polypharmacy inappropriate. But they do make it more likely.

What can I do to prevent inappropriate polypharmacy?

Inappropriate polypharmacy is extremely preventable. Some of the most important things you can do include:

• Always carry an updated, paper copy of your medicine list. It should include what you take, the dose, why you take it and who prescribed it. A paper copy can tell providers what you take even when you can’t.
• Ask questions about your medicines. You should know the name of every medicine you take and what it does. If you’re over 65 and your provider prescribes a medication listed under the Beers criteria, this is especially important.
• Have a primary care provider. Make sure you see them for regular check-ups (at least once a year).
• Tell your provider about EVERYTHING you take regularly. That includes supplements, herbal products and over-the-counter medicines. (If you aren’t sure whether it counts, ask about it.)
• Try to get all of your medicines from the same pharmacy. That makes it easier for pharmacists to catch potential medicine issues.
• Ask about ways to take fewer medicines or lower doses. Medicines can make an amazing difference in your health. But if there’s a way to get the same effect and rely on medicines less, that’s worth asking about.