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While there is no set definition for polypharmacy, the term usually refers to the practice of taking 5 or more medications at the same time. The medications could be over-the-counter medications, medicines prescribed by the treating doctor, and other supplementary medicines.

Polypharmacy by itself is not bad for the patient as the patient may have multiple health conditions, and the use of five or more medications may be essential and beneficial. What is to be guarded against is overprescribing, prescribing drugs that interact harmfully with one another, and prescribing drugs with undesirable side-effects.

Therefore, it becomes essential to differentiate between appropriate and inappropriate polypharmacy.

Understanding the Difference

While prescribing 5 or more medicines increases risk of adverse drug interactions and adverse events, having a cut-off for the number of medicines prescribed is not possible as certain conditions necessitate use of 5 or more medications.

Who is at Risk of Inappropriate Polypharmacy?

Older adults and people afflicted with multiple conditions are most at risk of inappropriate polypharmacy.

While in the latter case, the reason for risk is obviously the concurrent prevalence of multiple health conditions, in the former case, i.e. older adults, the reason for increased risk is not due to this one factor alone. A decrease in the organs’ ability to function effectually is the other reason. This is because as people age, their organs’ capability to work changes – the kidneys, liver, etc. might not perform as effectively anymore. As a result, the organs’ ability to metabolize medicines reduces and the risk of side-effects increases.

Other than these two major sectors, people with unhealthy lifestyles, poor living conditions and lack of awareness are also at risk of inappropriate polypharmacy.

Ensuring Medication Safety

Appropriate Prescribing:

This is the foundation of ensuring medication safety. It involves the following:

• Having clarity on how the medicines are going to benefit the patient.
• Analyzing the benefits and risks of the medication thoroughly.
• Finding out what medicines the patient is currently taking or has taken in the recent past.
• Getting all information about previous drug allergies, drug reactions, etc.
• Looking into other factors that may affect treatment – pregnancy, aging, etc.
• Making sure the patient’s preferences are understood and the patient agrees with the medicines prescribed and understands the reasons for prescribing.

There are a number of points of care where medication safety can be ensured. These include:

• When first starting treatment
• While prescribing medicines
• When adding a new medicine
• During a follow-up
• When patient moves across healthcare settings

Deprescribing:

This is a planned and supervised process in which medicine dosage is tapered off and stopped. Deprescribing is done when medicines which were once benefiting the patient are no longer proving useful. However, stopping medicines can have side-effects and hence deprescribing should be done under the guidance of a healthcare professional.

The aim of deprescribing is to manage inappropriate polypharmacy and reduce unnecessary medication cost to the patient. Deprescribing has been shown to promote cognitive health, reduce falls and improve quality of life for the patient.

The Deprescribing Process

• Review all the medications the patient is taking.
• Collect information on whether the patient is indeed taking all the medicines, the side-effects and the regimen followed.
• Together with the patient, identify any incorrect, needless and harmful medications.
• Deprescribe these medicines while educating the patient on why they are being deprescribed.
• Patient involvement in deprescription is crucial as some patients may resist because they may fear relapse or deterioration of the condition. But once the reasons are explained, they will cooperate.
• Keep reviewing the medications at regular intervals.

Patient Education

This is a component which cannot be ignored while addressing inappropriate polypharmacy.

• By educating patients we empower them to be a part of their treatment process, and this has been shown to result in not just improved outcomes but also safer processes.
• Especially in the case of polypharmacy, patients need to know what drugs they are taking, why they are taking them, their side-effects and possible harmful drug interactions.
• When patients are educated on polypharmacy and its associated risks, they will not only be cautious and question their medication regimen, but they will also not indulge in self-medication.
• Education helps patients understand the importance of medications review and they will strive to not miss follow-ups.

Integrated Care by Healthcare Professionals

• Other than the aforementioned practices of appropriate prescribing, deprescribing and patient education, healthcare professionals can further tackle inappropriate polypharmacy by working with other doctors involved in the patient’s care along with pharmacists and nurses.
• Cross-collaboration helps understand the patient’s condition better and leads to improved outcomes.
• Finally, healthcare leaders should take the lead in educating healthcare professionals on the importance of medication review to mitigate the harm that comes from inappropriate polypharmacy.

Frequently Asked Questions

What is polypharmacy?

Polypharmacy refers to the use of five or more medications at the same time, including prescription drugs, over-the-counter medicines, and supplements.

Is polypharmacy always harmful?

No. Polypharmacy can be appropriate and beneficial when multiple medicines are necessary to manage different health conditions. Problems arise when medicines are unnecessary or interact negatively.

What is the difference between appropriate and inappropriate polypharmacy?

Appropriate polypharmacy uses multiple medicines with clear benefits, no harmful interactions, and patient agreement. Inappropriate polypharmacy involves unnecessary drugs, adverse interactions, or medicines that cause harm or discomfort.

Who is most at risk of inappropriate polypharmacy?

Older adults and people with multiple chronic illnesses are at higher risk. Reduced organ function with aging can affect how medicines are processed, increasing side effects.

What are the risks of inappropriate polypharmacy?

Risks include adverse drug reactions, drug interactions, poor medication adherence, falls, cognitive decline, hospital admissions, and reduced quality of life.

What is deprescribing?

Deprescribing is a planned and supervised process of reducing or stopping medicines that are no longer beneficial or may be harmful. It should always be done under medical guidance.

How does deprescribing benefit patients?

Deprescribing can reduce side effects, lower medication costs, improve cognitive health, decrease fall risk, and enhance overall quality of life.

How can patients help prevent medication-related problems?

Patients should know why they are taking each medicine, report side effects, avoid self-medication, attend follow-ups, and participate actively in medication reviews.