Any practicing pharmacist like myself will most likely encounter multiple patients with potential polypharmacy problems on a daily basis. The term “polypharmacy” refers to the concurrent use of multiple medications by a patient for one or more medical conditions.
Polypharmacy is most prevalent in older adults. It’s reported that 42% of adults age 65 or older are taking five or more prescription drugs. It’s not uncommon for me to see medication profiles of patients who are taking two or three times that number of medications… sometimes even more! When you add the nonprescription “over the counter” medications and other additional supplements, the risk for side effects or adverse reactions is even greater.
Maybe you find yourself wondering if you’re taking too many medications. In many cases, there are valid reasons for taking multiple prescription drugs. But it’s important to remember there is always an increase in potential drug-related problems when multiple medications are prescribed together and when prescriptions are added to treat side effects of other drugs.
The Potential for a Prescription Cascade
Polypharmacy can result from several different reasons. Your doctor may be treating you for multiple medical conditions, or your disease may have changed or progressed over time. Sometimes a new medication is prescribed to treat symptoms that are actually side effects of a medication you are already taking. These side effects may look like a “new disease,” causing symptoms that require additional medication. This can create a cycle known as a “prescription cascade.”
There are times when a physician is faced with treating the side effects of one medication with another medication. Some cancer chemotherapy medications will cause nausea as a side effect. This may be treated with an anti-nausea medication. The anti-nausea medication may have the side effect of causing headaches, so another medication is used to treat the headaches. All these medications can have side effects.
And the side effects of each of the medications above may lead to another medication being prescribed. That’s how the prescribing cascade cycle increases the number of medications a patient takes.
Increasing the number of medications you take can lead to other problems as well. It can make it difficult for you to manage your medications properly and adhere to your medication schedule. It can also lead to mistakes, like taking medications at the wrong time or mixing them up and taking the wrong medication.
Medication Therapy Management Can Lower the Number of Drugs You Take
So, how do you manage to balance out the number of medications you take? I suggest you start by asking your pharmacist if you qualify for a medication therapy management (MTM) evaluation. Many patients can receive a no-cost pharmacist MTM evaluation paid for by Medicare or other health insurance. An MTM review will help determine if your medications are necessary, effective and safe for you to take. You may be asked questions about your well-being or quality of life to determine how the medications affect you. The evaluation may also explore ways to reduce your medication costs by making medication changes or substitutions. Your pharmacist can then work with your doctor to deprescribe or discontinue unnecessary medications or medications causing problems.
Polypharmacy cannot always be avoided, and shouldn’t always be looked at as the enemy. But any patient taking multiple medications will benefit from a medication review and assessment for safety, effectiveness and to ensure you’re taking your medication properly.
