All you need to know about polypharmacy


When I decided to write about polypharmacy, I thought back to my father’s final ten years and the large white bag of pills he carried with him. I was in charge of giving him each medication at the appointed time. I was unsure if his body could manage all of these meds. But as a doctor today, I understood how risky that was.

I will now take you on a journey to understand what polypharmacy is and how it affects us.

What is polypharmacy?

Polypharmacy is, defined as the continuous use of at least 4-5 medications due to multiple health issues.

Polypharmacy in older adults.

According to a World Health Organization study, there is one elderly person, or someone 60 years of age or older, for every nine persons.

Chronic illnesses like diabetes, heart failure, kidney disorders, arthritis, and hypertension become more common as people age.

As a result, older adults tend to take more than one medication a day for these health conditions which are named polypharmacy.

Additionally, we must be aware of Beers criteria in order to prevent the negative effects of polypharmacy in older persons.

Beers criteria

Were originally developed by Mark H. Beers in 1991, for potentially inappropriate medication use in older adults. It is used by the American Geriatrics Society (AGS). The objectives are to improve drug selection, advise doctors and patients, prevent side effects, and assist in evaluating care quality and medication use trends for older persons.

Beers criteria examples

GlimepirideHigh risk of prolonged hypoglycemiaAvoid
Rivaroxaban (Xarelto)Increases the risk of serious bleedingAvoid
Gabapentin (Neurontin), or Pregabalin (Lyrica)Severe respiratory depressionAvoid
Rivaroxaban and dabigatranHigher bleeding riskAvoid
Beers criteria

Now, we have to ask ourselves

Why is polypharmacy risky for elderly people?

Due to age-related metabolic changes and decreased medication clearance, elderly adults are more susceptible to adverse drug reactions (ADRs).

Also, using so many medicines increases the chance of drug-drug interactions.

Polypharmacy leads to prescribing cascades, a term said when symptoms of adverse drug reactions occur, are misdiagnosed as an illness, and a new drug is added to the list of medications, this increases the probability of developing new symptoms and thus results in prescribing cascades. 

There are risks associated with multiple medications, such as

  • Reduced adherence.
  • Drug disease interaction.
  • Drug-drug interaction.
  • Increased drug costs.
  • Prescribing cascades.

Polypharmacy symptoms

Every drug has side effects, so if you take several in a day, you may experience symptoms like

  • Mental health issues
  • Memory problems
  • Liver problems
  • Hospitalization
  • Tiredness
  • Dizziness
  • Weight loss
  • Constipation
  • Anxiety 
  • Confusion
  • Falls

How to avoid multiple medications

  • Doctors should review the drug doses of older people periodically to decrease the incidence and side effects of multiple medications.
  • If possible, healthcare providers should provide a single medication rather than several medications to manage a particular condition.
  • When clinically necessary, medication dosages should be initiated at a lower level and gradually increased as needed.
  • Drugs that may be administered once or twice a day are preferable to those that must be taken three times a day.
  • Discontinue unnecessary drugs immediately.
  • Stop the medicine that does not show either a therapeutic benefit or a clinical indication.
  • Unnecessary medications prescribed by many healthcare providers for the same disease should be discovered and removed.

Finally, Patients can achieve better outcomes and a higher quality of life by recognising polypharmacy early and preventing it. Reviewing medications is crucial to avoiding the side effects of taking many medications.