- Polypharmacy tends to be prevalent in older adults, who may struggle with several health problems at the same time and, as a result, need more medication
- While sometimes necessary, this poses risks, including adverse drug effects like cognitive impairment, harmful drug interactions, and drug-disease interactions, in which a medication prescribed to treat one condition worsens another or causes a new one
- If you think you might be taking too much medication, the first step is to catalog everything that you're taking and talk to your primary care physician
The Risks of Taking Multiple Medications
Sometimes, taking multiple medications is essential to your health. But it can also be dangerous; the use of multiple medications increases the risk of adverse drug effects, including cognitive impairment, harmful drug interactions, and drug-disease interactions, in which a medication prescribed to treat one condition worsens another or causes a new one. On top of that, it’s costly and stressful to manage buying, taking, and refilling multiple prescriptions.
What Is Polypharmacy?
The use of multiple drugs to treat diseases and other health conditions is known as polypharmacy. Some experts get more specific, defining polypharmacy as regularly taking five or more medicines, but it's complicated: Many patients can and must take more than five medications to stay well and keep chronic conditions at bay (assuming they’re prescribed thoughtfully and safely). On the other hand, taking just a few medications that interact or don’t agree with you can cause massive problems. The COVID drug Paxlovid, for example, interacts with dozens of commonly taken medications that must be lowered or paused during the typical five day course.
Polypharmacy tends to be particularly prevalent in older adults, who may struggle with several health problems at the same time and, as a result, need more medication. It can also be magnified when you see several different physicians, some of whom may not be in the loop on who’s prescribing what.
What To Do if You’re Concerned
There are two reasons patients typically become concerned they’re taking too much medication. The first is that although they’re not experiencing any new symptoms, they’ve seen the number of daily pills they’re taking continue to climb, and they simply don’t like the idea of putting so many drugs into their body. The second is that they’ve noticed a new, concerning symptom that might be correlated to a medication or combination of medications.
Catalog Everything and Talk to Your Primary Care Physician
Make sure all medications you’re currently taking are listed in your Medical 101 Sheet with the correct schedule and dose. And be sure to add all supplements as well — it’s essential that you include both traditional and alternative medicines. Vitamins and supplements can interact with medicines, as can certain foods.
Make sure your primary care physician knows everything that you’re taking. They may be unaware of visits you made to sub-specialists or other providers who have given you additional prescriptions. If a new symptom or concern is driving you into their office to do the review, make sure to make that clear.
Have Your Physician Explain Why Everything You’re Taking Is Necessary
Have your primary care physician explain why each of the medications you’re taking is needed. You might be surprised to find that during this review, you discover that certain drugs can be stopped. Sometimes, a symptom or disease that’s being medicated remits or improves to the extent that a medication is no longer needed but it’s still in your regular line-up. For example, if you were prescribed an antidepressant during a particularly difficult time in your life but are finding yourself feeling much better, you and your doctor may decide it no longer makes sense to take one.
Working With Your Physician to Consider a “Drug Holiday”
If there’s reason to believe a particular symptom might be caused or exacerbated by medication, your physician might suggest a closely managed and monitored drug holiday. During a drug holiday, you and your physician will make a plan to stop one medication at a time to see if a concerning symptom resolves. If you see resolution, they might suggest a re-challenge: restarting the medication to see if the symptoms return to “crack the case” definitively.
Drug holidays are complicated and must be done under the close supervision of a physician. Never stop a medication without alerting your physician, as there are some medications that simply cannot be stopped depending on your particular history (like insulin for diabetes). Keep a careful daily diary of the symptom in question to understand if it’s improving, worsening, or staying the same. There are some excellent smartphone apps for this purpose (we like Flaredown).
How to Learn About Drug Interactions
In addition to your physician, two of the best resources to learn about drug interactions are WebMD’s Drug Interaction Checker and Drugs.com’s Drug Interaction Checker. Using these should never replace working with your doctor, but can be good resources to get additional information.
It’s also important to note that many medications interact with foods in addition to other drugs. As an example, on the anticoagulant Coumadin, you should avoid leafy greens like spinach and kale that are rich in Vitamin K, which plays a role in forming blood clots. The widely prescribed statin Lipitor causes a dangerous interaction when mixed with grapefruit.
Medication errors and interactions are responsible for millions of hospital admissions annually. With a little due diligence, you can stay out of trouble.