When Too Many Medications Becomes a Risk

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What is polypharmacy

• It refers to the use of multiple medications by one individual, typically 5 or more at the same time. 
• The Royal Pharmaceutical Society describes polypharmacy as a serious and growing public health challenge.
• As people live longer and develop multiple conditions, the number of medications prescribed often increases.
• Taking more medicines increases the risk of side effects, medication errors and interactions.

When is it a concern?

• Some polypharmacy is appropriate and necessary. However, in some cases it can become excessive or unsafe.
• It becomes problematic when the potential harm of taking several medications outweighs the benefits.
• It also occurs when the individual does not understand what the medicines are for, how they work or the impact of not taking them properly.

What causes problematic polypharmacy?

2 common causes:

• When a person is under the care of multiple specialists. For example, someone may be seen by a cardiologist, a diabetes team and a gastroenterologist. Each specialist may prescribe medication for their specific condition but may not be fully aware of what the others have prescribed. This can result in duplicate treatments, interactions or unnecessary medication.
• Another common cause is that some medicines are intended for short-term use but are never reviewed. Over time, they remain on repeat prescriptions even when they are no longer needed. For example, a woman in her 80s who moved into a care home was still taking folic acid, despite not having had a folate test in years. She had originally been prescribed it during pregnancy more than 40 years earlier, and it never stopped. 

Medication review

• If you or someone you care for is taking several medications, contact the GP surgery to ask for a review.
• Most GP practices now have pharmacists who can carry out a full medication review.
• The GP may also refer you to a hospital-based polypharmacy clinic.
• These reviews consider the full picture, not just prescriptions from a single clinic or department.
• Since October 2020, anyone taking 10 or more medicines qualifies for a structured medication review.

Polypharmacy case study

• This case study illustrates how polypharmacy can build up quickly. 
• An 80-year-old woman who had previously been taking only paracetamol was later found to be on five different medicines, all introduced within just a two-year period.
• Only one medicine treated the original condition while others treated side effects. 
• She was first prescribed Ibuprofen for arthritis. Regular use of this raised her blood pressure, so she was started on Amlodipine. This caused swollen ankles, so Furosemide was added to reduce the fluid. This led to urinary frequency which affected her quality of life so Oxybutynin was introduced. Finally, it caused constipation so Macrogol was prescribed to manage that.
• This shows how quickly a simple medication regime can grow, sometimes unnecessarily and highlights the importance of regular reviews.