Polypharmacy is typically defined as concurrent use of 5 or more medications (prescription, over-the-counter, vitamins, and supplements) by the same person, often with the connotation that some number of these pills are not currently appropriate in one way or another. Examples of the reasons that can make medications no longer appropriate is that they interact with the other medications or conditions, represent therapeutic duplications, are no longer necessary, taken in too high or too low a dose for condition being treated or for the person’s current physical state, or they carry too high a risk of adverse effects.
Polypharmacy can creep up on people as they get treated for new diseases and conditions, see new healthcare practitioners and specialists, get admitted and then discharged from hospitals, and generally traverse our complicated and often fragmented health care system. A medication that got added because of a side effect from another medication can often linger even though the original offending medication was stopped long ago. Patients may not remember why they started taking a particular medication and their new doctor may hesitate to stop a drug that another doctor had started. Over time medications and supplements just keep getting added.
The overall pill burden can be a problem in and of itself. Multiple medications (prescription and not) make it more difficult to stay compliant with therapy. It is particularly a problem for aging individuals, for whom polypharmacy can lead to multiple adverse consequences, including increased risk of falls and fractures, bleeding complications, kidney and liver problems, confusion and worsening dementia, to name but a few. There is also significant cost in terms of diminished quality of life as well as direct and indirect financial impact.
What can patients do to address the problem of polypharmacy?
First of all, patients should seek a practitioner that will perform a regular medication review process to collect and update information on all medications taken so that each drug can be checked for potential need for adjustment or discontinuation. Many hospitals and physician practices are implementing systems to critically evaluate a patient’s pill burden with the goal of stopping inappropriate medications, but their efforts are often constrained by lack of time and other resources. Further, not all practices are equipped to obtain or maintain a complete medication list from the patient that includes all their prescriptions and non-prescription medications, as well as doses, times and manner of administration, and other important details.
Patients and physicians can also utilize the services of the healthcare practitioner that is uniquely qualified to compile and critically evaluate a comprehensive medication list – the pharmacist. Pharmacists 0perform a patient evaluation and compile a comprehensive medication history with times and manner of administration and then thoroughly analyze the gathered data for potential compliance problems, drug-drug, drug-supplement, and drug-food interactions, therapeutic omissions, duplications, and recommend dose optimization. Pharmacists also work with both the patient and their physicians to address the identified issues.
Patients should always have an updated, comprehensive list of their current medications -- with notation of purpose of each item taken -- on them in order to share with all their health professionals as necessary. Any and all therapy changes should be promptly communicated to all their other healthcare providers, including the pharmacist. Comprehensive and up-to-date information is the key to making quality health decisions!
Greta Goldshtein, PharmD, APh
Greta can be contacted at greta@courtyardpharmacy.com