Polypharmacy: What is it and what is the risk for our health?
Published 23 Jan 2022 • By Courtney Johnson
As the older adult population and the number of young people with complex health conditions have grown in the United Kingdom, polypharmacy has become a problem of increasing importance.
But what is polypharmacy? What are the risks and how to manage it?
We answer these questions and more below!
What is polypharmacy?
As we age, the risk of developing chronic medical conditions rises. One of the consequences of managing multiple chronic illnesses is the daily use of multiple medications. Today, many people in the UK see multiple doctors or specialists, who each prescribe new medications or change dosages, which can further complicate an already challenging situation for patients.
Though its definition is still debated, the medical community has come to generally define polypharmacy as the use of five or more medications on a daily basis by an individual.
The prevalence of polypharmacy depends on multiple factors (including the precise definition of polypharmacy, the age group and geographic location studied), but is generally estimated to be on the rise.
In the United States, for example, CDC and National Center for Health Statistics analysis of prescription drug data has showed that the polypharmacy rate increased from 6.3% to 10.7% between 1999 and 2008.
Many countries are seeing a rapid growth of the older population aged 65 and older, as the baby-boomer generation ages and life expectancy improves, which can contribute to the increase in polypharmacy cases.
When is polypharmacy beneficial?
Polypharmacy can be used both appropriately and inappropriately. While polypharmacy is often looked at through a negative lens, prescription of multiple medications can be acceptable and even therapeutically beneficial in many cases.
“Appropriate polypharmacy” is a term used describe the prescription of more than one medication for multiple or complex health conditions in a way that only necessary medicines are used according to the best evidence for preserving the patient’s safety and well-being.
This kind of polypharmacy is clinically indicated for some conditions. Often, certain medications can have specific and intended positive interactions with one another when prescribed simultaneously, achieving a greater effect than any single medicine alone. This is particularly true in the areas of pain management and anaesthesia, where typical analgesics such as NSAIDs, prostaglandin inhibitors, opioids, and others are combined with atypical medicines like muscle relaxants, antiepileptics, antidepressants, NMDA antagonists, or other agents.
For example, in the first year after a myocardial infarction (heart attack), a typical treatment regimen includes: a beta blocker, a statin, an ACE inhibitor, aspirin, and an antiplatelet agent.
In all cases polypharmacy should be discontinued when it is clear that the benefit of the prescribed medications no longer outweighs the potential for harm to the patient’s health.
When does polypharmacy pose risks to our health?
While polypharmacy is often clinically necessary, especially when managing several chronic conditions, it does still carry several risks.
Taking many different medications at the same time can cause issues for both patients and clinicians.
For patients, managing, organising, and taking multiple medicines can be difficult to handle and can lead to mistakes in storing or taking them properly. Patients taking several different medications may forget to take them, take them at the wrong time, or take them too frequently. As a result, treatment can fail, the condition can worsen, drug reactions may occur, and the patient may end up hospitalised – all situations which can be potentially life-threatening.
For clinicians, it may be difficult to know or keep track of what medicines the patient is already taking, leading to prescribing errors or any of the situations described above.
Adverse drug reactions and interactions
Another concern when it comes to polypharmacy is adverse reactions. It comes with the territory – the more drugs, the higher the risk of drug interactions or reactions.
First, some medications lose efficacy when used with other medications that interfere with their action. This is known as a drug-drug interaction.
Additionally, a medication used for one condition or symptom may have a negative effect on another health condition or symptom. This phenomenon is known as a drug-disease interaction. For example, some anti-inflammatory medicines that are often used as pain killers may increase blood pressure and impact kidney function, so they should not be prescribed to people experiencing high blood pressure or kidney conditions.
How to manage polypharmacy?
Taking multiple prescriptions and over-the-counter medications can be overwhelming. To help manage polypharmacy, here are a few helpful tips:
- Keep an accurate, up-to-date list of any medications you’re taking. This should include prescribed medications, over-the-counter drugs, herbal remedies, and supplements, as well as their doses. Make sure to update it any time your prescriptions change.
- Make sure all your doctors and/or specialists are aware of what medicines you’re taking, including and especially any over-the-counter drugs, natural remedies, or supplements.
- Understand why you are taking each of your medications. Understanding what each medication is for can help you take an active part in your treatment and manage it better. Don’t hesitate to discuss with your doctor about what side effects to look out for or ask if any symptoms you’re experiencing could be related to a medication side effect.
- From time to time, discuss your medication regimens with your doctor. Some conditions or symptoms may negatively affect your health and quality of life, so managing them with appropriate treatments is critical. But other conditions or symptoms may have minor impact on your health or quality of life, so you may be able to go without additional medications. Ask your doctor if there are any medicines that are no longer necessary or if lifestyle changes (e.g. diet, exercise, weight loss, etc.) can help you to discontinue them.
- Adopt aids or tools to help you take your medications properly. If you have problems taking your medications correctly (i.e., at the right time, etc.) talk with your doctor about simplifying your treatment regimen or switching to medications that can be taken fewer times a day. To help, a number of virtual or physical tools are available (medication reminder apps on smartphones, daily or weekly pill organisers, etc.), and your doctor can help you identify the best options for you.
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