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! 

Polypharmacy: What is it and what is the risk for our health?

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. 

Drug mismanagement 

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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avatar Courtney Johnson

Author: Courtney Johnson, Health Writer

Courtney is a content creator at Carenity and focuses on writing health articles. She is particularly passionate about exploring the topics of nutrition, well-being, and psychology.

Courtney holds a double... >> Learn more

Who reviewed it: Antoine Seignez, Pharmacist data science project manager

Antoine holds a PharmD and a PhD in life sciences, specialising in immunology. He studied at the University of Burgundy in France. Several of his research projects have been published in international... >> Learn more


robjmckinney • Ambassador
on 29/01/2022

Yes both my wife and myself have carry bags of drugs delivered each month full of medicine. I vary mine depending how I feel or suffering, my wife has the dosset boxes and rattles as she walks. Now we get reviews by our Doctor's Pharmacist every year to discuss how we are getting on. The delicate balance of my wife's many drugs are always a question and many experiment of change by various Doctors/GPs create real issues so they leave her alone. But we do have regular events through small colds etc. that throw her into low blood pressure issures. Sometimes I drop certain drugs like Losartan and her blood pressure recovers and she can restart her full meds or we end in A&E. For me just had my review this week and was able to discuss my issues of being unable to swallow tablets due to post cancer issues. So all my meds are either liquid or disolvable, this required an extensive change in meds to other types. Finally got my Naproxen back as they have a chewable version today so I can dump my diclofenic, is a perfect example. But I am worried of the taste of my new liquid versions as I changed Metformin to liquid years ago and it tastes foul.

So yes adapting medicines is essential but clearly with advice from your GP especially if you have complicated array of medicines. All GPs should be reviewing your meds every year these days so for most of us not an issue!

Mrs E Larkin • Ambassador
on 29/01/2022

Fascinating subject Poly Pharmacy, particularly as I had my very first review this week! The Pharmacy Clinician took great interest in my meds and how long I've been taking them, I was very impressed at how thorough she was as I am 63years old and take six types of meds daily and never had a review before!

Your article explains why, after all these years so.eone is on my side in looking at the bigger picture and not only one condition! I even managed to be referred to my actual GP, not seen in two years, for something recent and was sent for bloods. Without this review I may never have got to see my GP and I'm very relieved!

lesmal • Ambassador
on 29/01/2022

Thank you for explaining this subject more.

I am on at least 7 different medications for hypothyroidism, epilepsy, osteoporosis, stomach reflux, and high blood pressure. I also now have to take Aspirin for life after brain aneurysm surgery in 2019. They all mount up and obviously one reacts with another, thus the constant side effects that come with them.

Most of the above ailments are treated with one medication only, however, it is common for people with epilepsy to be on 2 or even more AEDs to try and alleviate the seizures, and make it better for the patient. Luckily, I am only on 2 AEDs but many others who struggle with seizures are on 3 or 4 different types. My Pharmacy is excellent at asking if I'm compatible with the medications, how I'm doing as the months go on, and if any problems with side effects and more, I know I can speak to my Doctor or Epilepsy Nurse.

How I'd love to be off the medications in order to have some breathing space but regret this won't happen!

JazzyC • Ambassador
on 10/07/2022

I honestly couldn't tell you off the top of my head how many different medicines I am on but its at least a dozen. When I go to pick them up from the dispensary I just ask for the shipping order. All joking aside it can be a nightmare if you see a different Dr every time. I am supposed to have a medical review every July but it usually consists of someone unknown person ringing me up, reeling the medicines off and asking if that right, really helpful. Over the years I have tweaked some of the medicines such as tramadol so I don't take the full recommended dose per day. ¹I have just been diagnosed with secondary lung cancer so no doubt my daily total of different tablets and inhalers will go up again

This was a very useful article by the way

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