Potential Problems of Polypharmacy

By AJ Guimond, PharmD Candidate, Class of 2022
University of Arizona

April 26, 2022

Polypharmacy 2022

Polypharmacy (poly = many) is a major problem in healthcare that happens when a patient is taking multiple medications. There is no exact classification of polypharmacy, but it is commonly defined as having five or more prescriptions a day.

Taking many medications is strongly associated with a higher risk of side effects, drug interactions, and even death in extreme cases. Fortunately, this can be preventable and fixable if you know what to look for. Understanding polypharmacy and how to prevent it may just save a loved one’s life or your own!

What causes polypharmacy?

Polypharmacy may happen for many reasons. In some cases, patients may truly need a multitude of prescriptions. This is most often seen in very serious medical problems, such as transplantations, cancer, or someone with multiple medical conditions. However, many other patients may end up taking extra prescriptions that may be unnecessary.

Here are some of the most common ways polypharmacy may happen:

  1. Having multiple doctors. Some patients see several doctors, as some are more specialized in specific areas of medicine than others. It is perfectly fine to have more than one doctor, but it may lead to communication issues between your other doctors. Despite technology advances, most doctor’s offices and hospitals are not able to communicate freely with each other through their computer systems. This may lead to them unintentionally prescribing extra, unnecessary, or even duplicate drug treatments.
  2. Continuing drugs from hospital visits. When people are in the hospital, they are often given one or more drugs that are not part of their normal treatment. Once released from the hospital, some patients may be provided a short supply for a drug to take temporarily. This is seen most often with over-the-counter (OTC) drugs such as pain relievers like ibuprofen (Advil, Motrin) or OTC stomach-relief drugs such as omeprazole (Prilosec). Patients may not know that these may be meant to be temporary and continue to take them for months, or even years, longer than they should.
  3. Side effect management. Medication side effects are extremely important to consider when doctors give prescriptions. Every medication has possible side effects, and doctors often use other drugs to relieve these side effects. This can lead to an increase in the number of medications being taken, often called the “prescribing cascade.”

Risks of polypharmacy

Aside from the higher costs of having more medications, polypharmacy can cause several other problems. Possible issues include:

  1. Increased side effects. To put it simply: more medications = more potential side effects.
  2. Drug interactions. Many drugs work through similar bodily processes and are metabolized by the same enzymes. This may cause either a build-up or an inadequate amount of one or more drugs in your body. Too much build-up of a drug can cause side effects, and too little of a drug will be much less effective in helping treat a disease.
  3. Non-adherence. More drugs in your regimen can make it difficult to manage all of them. You may be prescribed drugs to be taken at different and/or multiple times per day. This can make it easy to forget a dose or even take more than prescribed.

    Adherence to medications is possibly the most important factor to how well they may work. With more complicated drug regimens, the possibility of using medications incorrectly can dramatically increase.

Note: Simple ways to improve medication adherence include using a weekly or monthly pill organizer and using the free
ScriptSave WellRx app with pill reminders.

  1. Worsening disease. Some drugs do not mix well with certain diseases and may cause them to get worse. For example, ibuprofen and some other OTC pain relievers may cause stomach issues in some patients. If you have a stomach problem, such as acid reflux, ibuprofen could make it worse. It is very important to understand which medications may cause worsening disease before starting them. If you see that a medical problem worsens upon starting a new medication, contact your doctor immediately.
  2. Issues in elderly populations. Older people are often much more susceptible to side effects of medications compared to younger generations. This is because they tend to have decreased metabolisms, higher body fat, lower muscle mass, and less water in the body. These factors can make it more difficult for certain drugs to distribute throughout the body as intended. If a drug is not distributed properly, it may lead to worse side effects or less-effective drug treatments. They may also be at a higher risk of serious or life-threatening complications, such as falls.

How can polypharmacy be prevented?

If you feel like you are taking too many medications, talking to your pharmacist and doctor(s) should be the first step to addressing the problem. You should discuss concerns with them you have about your medications, side effects, and effectiveness of your drug treatments.

Talking to your pharmacist. Your pharmacist has the knowledge, resources, and accessibility to make optimizing your medications simple. They can review your entire list for potential side effects, drug interactions, and unnecessary medications. If your pharmacist notices any problems in your drug list, they can provide suggestions for you to do and even contact your doctor to make immediate changes if the problem is serious. Pharmacies often get very busy, so it is recommended to schedule an appointment to review your medications in person or via phone call or video chat.

Talking to your doctor. In some cases, some of your medications may not always be the most appropriate treatment for you. To limit this risk, make an appointment with your primary doctor to discuss your prescribed drugs. Make sure you bring a list of all your medications (including over-the-counter drugs and supplements) so your doctor can be as thorough as possible. Be open and honest with them about your medications, as this will make it much easier to build an appropriate drug regimen.

Polypharmacy is one of the biggest problems in healthcare across the nation. By understanding the process and reasoning behind why it happens as a patient, you may be able to prevent or fix this problem for you or your loved ones. The major factor to prevent polypharmacy is communication between you and your healthcare providers.

Always be as thorough and comprehensive with your doctors and pharmacist as possible. They are there to help you manage your disease(s) and can work with you to make your drug regimen as simple and effective as possible.

Resources:

Association between polypharmacy and death: A systematic review and meta-analysis - PubMed (nih.gov)

What is polypharmacy? A systematic review of definitions (nih.gov)

Polypharmacy - an overview | ScienceDirect Topics

Polypharmacy - StatPearls - NCBI Bookshelf (nih.gov)

Polypharmacy: Evaluating Risks and Deprescribing - American Family Physician (aafp.org)

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