Polypharmacy Awareness
January 22, 2025
Have you wondered if you are taking too many medications?
You are not alone. Taking many medications is referred to as “polypharmacy.” This term applies when a person regularly takes at least 5 medications. In 2020, it was reported that 43% of older adults regularly take at least 5 prescription medications. When you include over the counter (OTC) medications, two-thirds of older Americans take at least 5 medications regularly. Since 2000, this is an increase of 200%! While medications can improve quality of life, each one has side effects. The odds of experiencing a serious adverse reaction to a medication increases 7-10% with each additional medication. Let’s discuss some ways to make your medication regimen as safe as possible.
A common way to end up on multiple medications is something called a “prescribing cascade.” This occurs when one medication causes a side effect, so a second medication is prescribed to help reduce those adverse effects. Sometimes cascades are necessary, and other times they can be avoided. Here is an example:
- You are prescribed a medication for high blood pressure, which has caused lower leg swelling.
- Then, you are prescribed a diuretic (to increase urination) to reduce the swelling, but now you visit the bathroom more often.
- Next, you are provided a medication to reduce trips to the bathroom, but now this causes dry mouth and constipation.
This sequence can continue on and on, and not just for blood pressure medications. Let’s look at the example given. If it were possible to replace the original blood pressure medication with another that does not cause swelling, the prescribing cascade and the resulting hardships could have been avoided. OTC medicines, (medications you buy without a prescription like pain medications, cough and cold, sleep aids, vitamins, medications for bowel movements), are not without hazard. The risk for side effects greatly increases with age. The use of NSAIDs (aspirin, ibuprofen, Advil, naproxen, Aleve, etc.) for pain may be safe when you are younger. But as you age regular use increases the risk for gastrointestinal (GI) bleeding, heart attacks, strokes, and kidney disease. For those on a blood thinner (like Eliquis, aspirin, Xarelto, clopidogrel), NSAID use greatly increases the risk of GI bleed and anemia.
Another OTC drug effect I find most people are not aware of are “sleep aids.” The active ingredient is almost always diphenhydramine or doxylamine. They are marketed as “sleep aid” or “PM.” These medications are strongly associated with next day sedation (sometimes referred to as “hangover effect”), confusion (including dementia), constipation, falls, dry mouth, urinary retention, and blurred vision. Each of these medications will state you should use extra caution when used by older adults. However, this is often in fine print and hard to find on the package. There are more drug concerns for OTC medications. We recommend that at your next visit with your provider, you make them aware of your OTC medication use.
If you are taking 5 or more medications, it is recommended to have your medication regimen reevaluated every year or two. This is especially important for medications you have taken for a long time as there is a chance that they are no longer needed. This is doubly important for medications that affect the brain which include sleep medications (prescribed and OTC), Other medications to monitor include those for anxiety, depression, or other mood modifiers, and pain medications. As you age, these medications have a greater risk for causing falls and confusion, among other side effects. The older you are, the greater the impact from these medications. Doses that were necessary 20 years ago may be overwhelming now. For medications that affect the brain, side effects could look like increased anxiety or insomnia. Other medications could cause daytime fatigue or exhaustion. If any of these medications can be stopped, symptoms may improve without needing another medication.
If you are interested in reducing your medications, there are safe ways to do it. First, we suggest you do not make these changes on your own. Sometimes a medication that seems irrelevant might be the best medication we know of to prevent a heart attack or stroke. Next, when you meet with your provider, express an interest with reducing pill intake. There is a method to doing this because not all medications are considered equal. In our clinic, our goal is to identify the lowest effective dose of every medication. Sometimes that means a medication dose must be increased. Typically, it means we reduce the dose to evaluate continued need for a medication. If we reach zero and it is not needed, the medication may be discontinued. Finally, we want the dose reduction to be successful. Some medications should have their doses reduced slowly, while others can be stopped “cold turkey.” We can provide advice to not only reduce your pill intake, but also make your regimen as safe as possible. Completing this task every 1-2 years can make your experience with medical therapies more specific to your current needs and keep you healthier in the long run.