Polypharmacy: why taking multiple medicines needs close monitoring
Polypharmacy can be necessary for people with multiple chronic conditions, but regular medication reviews can help ensure that each medicine remains appropriate and safe
Deepina Pal, 26, has lived with chronic kidney disease since she was 16 and relies on dialysis for nine years. She takes around 10-12 different medications daily for various autoimmune and chronic conditions, including blood pressure, cholesterol, thyroid, heart, and migraine issues. Her medications require multiple doses throughout the day, prompting her to use alarms and record her intake on her phone.
When first prescribed blood pressure medication, Deepina experienced severe drowsiness, with her family later realizing her blood pressure had decreased.
A key factor in managing multiple medications is monitoring them closely. Polypharmacy, defined as using five or more medicines, is prevalent among older adults with multiple chronic conditions. According to a study of 11,649 older Indian adults, 49% and 31% experienced polypharmacy and hyperpolypharmacy, respectively. However, not every case of polypharmacy is inappropriate.
The concern arises when medications no longer provide clear benefits, duplicate each other, cause adverse interactions, or create a treatment burden outweighing their benefits.
Experts emphasize that medication safety is crucial in polypharmacy. Mismanagement can occur when specialists prescribe medicines independently, leading to duplicates. Drug combinations may also pose risks, such as potassium and kidney function issues from heart failure medications, and interactions between antifungal and anti-epileptic drugs. Extra doses can be dangerous, potentially causing hypoglycaemia from excess diabetes medication or triggering seizures if anti-epileptic drugs are missed.
Older adults face greater vulnerability due to age-related changes, kidney or liver impairment, frailty, cognitive problems, and multiple illnesses, all of which can impact medication handling. Side effects like low blood pressure, low sodium, dizziness, and confusion raise the risk of falls. To mitigate these risks, medication reviews should evaluate the necessity, appropriateness, and potential side effects or interactions of each medicine.
Factors such as kidney and liver function, nutrition, cognition, mobility, falls risk, cost, and difficulties with swallowing or complex timings should also be considered.
Doctors recommend patients bring all their medications to appointments, enabling a comprehensive "brown bag" review to identify duplicates and over-the-counter, herbal, or alternative products. This review should be shared among specialists, especially after hospitalisation or treatment changes. Pharmacists can assist in identifying interactions and dosing issues.
Pill organisers and alarms can help reduce missed or repeated doses. When a medicine's benefits no longer outweigh its risks, a careful process called deprescribing should be followed, avoiding abrupt discontinuation. Electronic prescribing systems can help flag some interactions and duplicates, but clinical judgement remains essential.
Written by urgent.news from The Hindu Health's reporting — not their text. Machine-written — may contain errors; check the original before relying on it.
