Polypharmacy

A Modern Day Side Effect

Polypharmacy is defined as excessive or unnecessary use of prescription or nonprescription medications (including over the counter (OTC) medications, herbals or vitamins). But what does excessive or unnecessary mean? Are two, three, four, five or more drugs too excessive?   To identify polypharmacy, we look for prescription medications that are being used for no apparent reason, the use of several medications to treat the same disease or condition, using extreme dosages, using medications, herbal supplements or vitamins that interact with each other, and using a medication to treat an adverse drug reaction from a medication the patient is currently taking.

It is estimated that 1/3 of all prescriptions filled in the United States are unnecessary. This high amount is partly due to patients demanding a prescription when they visit their physician. Many patients believe that there is a safe, quick and effective medication to treat every symptom they experience and do not consider unwanted side effects and/or drug interactions. Polypharmacy is a concern for older Americans since they only make up 13% of the population, but account for nearly 30% of all the medication used in the country.

There are two questions you need to ask yourself.

Am I at risk for polypharmacy? If you answer yes to any one of the following questions, you should talk with your pharmacist or physician about completing a thorough medication review.

  • Do you take five or more prescription medications?
  • Do you take dietary supplements, vitamins or over the counter medications?
  • Do you take homeopathic or herbal products?
  • Do you have your prescriptions filled at multiple pharmacies?
  • Is more than one physician prescribing medications for you?
  • Do you take your medications more than once a day?
  • Do you have trouble opening your medication bottles?
  • Do you have poor eye sight or hearing?
  • Do you live alone?
  • Do you have a hard time remembering to take your medications?

How can I help prevent polypharmacy from occurring in me?

  • On receiving a new prescription from your Doctor, ask 1. What is the medication for and what should the medication do?  2. What adverse effects are possible?  3. Are there any drug interactions with the medications, vitamins, over the counter medications or herbals that I am taking?
  • When you have your prescription filled, always ask the pharmacist 1. What should the medication do?  2. What adverse effects are possible?  3. Are there any drug interactions with the medications, vitamins, over the counter medications or herbals that I take?
  • Always read the labels and follow the directions.
  • Always have your prescriptions filled at the same pharmacy.
  •  Learn the names of your medication and why you take them.
  •  Make a list of every medication you are taking, including vitamins, OTC medications and herbals; update list after every doctor’s appointment.
  • Carry your medication list with you everywhere, especially, when you go to see your Doctor.
  • If you have more than one Doctor, assure each knows what the other is prescribing.
  • Avoid combining products like cold remedies and ask for help buying only the specific medication that treats the symptoms you are experiencing.

 

A good example of a patient with polypharmacy is Ella Mae, who takes 15 different medications (prescriptions plus vitamins).  She made an appointment with her Doctor to ask if any could be discontinued, fortunately one was.  In addition to speaking with her Doctor, Ella Mae gathered every bottle of medication that she was taking and put them into a grocery bag and called a pharmacist who did a brown bag review.  The pharmacist reviewed each one of her medications and told her how it functioned and how and when to take it.  Surprise!  She was taking 2 medications at the wrong time of day. Another medication would be safer if it were enteric coated. The Calcium that she was taking here and there needs to be taken everyday in two divided doses. In addition, Ella should be taking Vitamin D with her Calcium. After age 65 Calcium is not stored and bones can become honeycombed and brittle due to lack of Calcium.  The pharmacist asked Ella Mae about the dosage of Niacin she used. If she used a large dosage, she would need to take an aspirin to reduce the adverse effects (flushing and itching) of niacin.

She learned drinking grapefruit juice can affect the use of Calcium Channel Blockers, a heart medication.  Also if you are taking certain antibiotics your intake of dietary products should be reduced.

How can you stop being a polypharmacy statistic?  Next time you go to your doctor, bring all of your medications (including prescription, over the counter medications, herbals and vitamins) you use with you. Discuss your medications uses, potential adverse effects and potential interactions.  Know what you are taking and why.  Polypharmacy is avoidable.

Robert F. McClelland Jr., Pharm. D., C.D.M.
Pharmacy Manager at Craven Regional Medical Center

Ella Mae Rayner, RN
Author & Editor of the Community Resource Book
Executive Director of Coastal Health Resources, Inc.

 Brown Bag review done by a Realo Discount Drug Pharmacist

                            Back to Coastal Health Resources, Inc.                                    Back to LTC Alliance Homepage