Too Much

By Peter Galvin, MD

Polypharmacy is the excessive or unnecessary use of medications, both prescribed and over the counter (OTC) ones. Polypharmacy can affect anyone but is most commonly seen in older adults. Other risk factors include having more than one doctor prescribing meds, filling prescriptions at more than one pharmacy, having mental health issues, and living in a long-term care facility. Deprescribing is the act of reducing the number of medications a person takes. My many years of primary care practice taught me a very important lesson that I tried to instill in my patients – it is imperative that the primary care provider has an up-to-date list of all medications that a patient is taking, and that includes OTC meds and supplements. Not infrequently a patient would have their prescriptions changed by a specialist and neither the specialist nor the patient informed me of the change. Once a patient is admitted to a hospital, it is usually the primary care physician that orders the initial medications, not a specialist. So, there were occasions when I ordered medications for a hospitalized patient based on my own records, but unbeknownst to me the patient was taking completely different medications. It doesn’t take a rocket scientist to realize this could be catastrophic for the patient.

Polypharmacy can have serious consequences including:

• Adverse drug effects (like nausea, confusion, and bleeding)
• Drug-drug interactions
• Medication non-adherence
• Decreased mobility and falls
• Increased health care use (doctor visits, ER visits, and hospitalizations)
• Higher out-of-pocket costs

Steps to reduce polypharmacy include:

ü Bring an up-to-date list of all medications you take for every doctor’s visit, both primary care and specialist visits. Include OTC meds and supplements.

ü Talk with your doctor or pharmacist before starting any OTC meds or supplements. Both may interfere with prescribed meds.

ü When a new medicine is prescribed, be sure you know how long you should take it. Ask the doctor or pharmacist.

ü If you are taking a medication longer than planned, talk to the doctor or pharmacist to see if it is still needed.

ü Review with your doctor all medications that were prescribed after discharge from a hospital. Some may be needed only for a limited time.

ü Always try to obtain all medications from a single pharmacy. That way the pharmacist can spot potential problems, like drug-drug interactions.

If you think you are experiencing polypharmacy, always talk to your doctor before stopping any medications or altering doses. Never do this on your own. As people age, the benefits and risks of medications can change. Sometimes a non-medication lifestyle change or alternate medication is safer to manage a health condition. When your doctor is deprescribing for you, or decreasing the number of meds you take, be sure you know what to expect including any symptoms that may occur after stopping a medication. Deprescribing can lower your out-of-pocket expenses, lessen the risk of drug-drug interactions, and improve health. Properly dispose of medications that have been stopped, and never restart one on your own. If you feel you need to restart a med, be sure to talk to your doctor first.

For more information go to the website of the National Institute on Aging at: www.nia.nih.gov

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