Polypharmacy

Polypharmacy refers to taking multiple medications concurrently to manage coexisting health problems, such as diabetes and hypertension. Sometimes, polypharmacy becomes problematic, such as when patients are prescribed too many medications by multiple healthcare providers working independently of each other. Also, drug interactions can occur if no single healthcare provider knows the patient’s complete medication picture.

In addition, patients may contribute to the problem of polypharmacy by self-medicating, failing to follow prescribed directions, failing to report all medications or OTC products used, and borrowing or trading medication with other persons. Awareness of other therapies to which the patient subscribes is also essential. It is important to remember that the consequences of inappropriate polypharmacy can be particularly significant to an elderly patient’s well-being, financial security and ability to adhere to prescribed therapy. Prevention of unnecessary drug therapy problem can be conducted through reduction of drug use.

Approaches to reducing polypharmacy

1. Maintain an accurate medication and medical history: Identify all medications, including any over the counter (OTC) therapies. Having a complete list of medications can deter a provider from adding on an additional therapy. A complete history of your medical condition also is important. Identifying the medical history allows the pharmacist or other healthcare professionals to identify inappropriately prescribed medications. For instance, metformin is not appropriate for patients with end-stage kidney disease.
2. Link each prescribed medication to a disease state: Each medication should match a patient’s diagnosis. Any medication that does not match a diagnosis is potentially unnecessary, and an attempt to discontinue the medication should be made.
3. Identify medications that are treating side effects: The use of multiple medications leads to a higher risk of side effects. When side effects occur, additional medications can be initiated to treat the side effect. A common example includes the use of laxatives to treat the medication side effect of constipation. Discontinuing one drug that is causing a side effect can often lead to the discontinuation of several drugs.
4. Taking preventions during prescription: The appropriateness of the medication for the patient and the potential for side effects must be considered. Any drug that is unnecessary, inappropriate, or has a high likelihood for causing side effects that would require additional therapy should be avoided.