Polypharmacy: How Much Is Too Much?

Jan 21, 2013
Having multiple prescriptions puts seniors at greater risk of medication errors. But informed patients can help prevent the risks of polypharmacy.
  • Seniors

The numbers are staggering. On average, seniors take six different medications, and more than 15% of seniors use at least 10 drugs at the same time. More often than not, this is polypharmacy: when patients are on multiple medications, more than are needed to improve and maintain their health.

While there may be legitimate reasons for the use of multiple medications, it’s often the case that a number of the drugs are unnecessary and may even be harmful.

Cause and Effect of Polypharmacy

One major factor behind polypharmacy is that most seniors are under the care of several different specialist physicians who may not be aware of or as knowledgeable about medications the patient has been prescribed by other doctors. An Express Scripts study found that seniors who see two different doctors had an average of 27 prescription fills and were at risk for 10 medication errors each year. When the number of doctors caring for the senior increased to seven, prescription fills jumped to 52 and errors more than doubled (22) in a year.

Risks and Costs of Managing Multiple Medications

Managing multiple medications is daunting and can put patients’ health at risk. The consequences of taking numerous medications include:

  • Higher risk for adverse drug reactions
  • Increased likelihood that drugs taken together will interact poorly with one another, potentially causing dangerous and costly drug interactions
  • Greater odds that a drug being used for one condition will have a negative impact on another health problem (e.g., certain medications used to treat diabetes can worsen heart function and may not be appropriate for patients with heart failure)

Another harmful side effect of polypharmacy is inappropriate medication use and nonadherence. More complicated regimens can make adherence to the prescribed therapy more challenging. The consequences of medication nonadherence are enormous, costing the U.S. healthcare system $317.4 billion in 2011. Nearly one-third of this annual cost is due to nonadherence to drug treatments for diabetes, high cholesterol and high blood pressure/heart disease – medications commonly used by the elderly.

Patient Empowerment and Risk Prevention

Patients who take multiple medications should ask for a medication review and include all prescriptions, over-the-counter drugs and supplements used. Physicians will sometimes do these reviews, as can pharmacists – including those at your pharmacy benefit manager.

Patients should maintain a list of all their current medications so it can be easily reviewed by their doctor or pharmacist at each visit. It's a good idea to ask if all the medications are really necessary, if any of them may have potential harmful interactions and if lower-cost generics are available. Doing so can eliminate inappropriate or duplicative medications and often result in better health outcomes and lower costs.

Advanced data systems, such as RationalMed® Patient Safety Program from Express Scripts, also help reduce polypharmacy risks. RationalMed identifies potential polypharmacy issues and alerts pharmacists and physicians so that changes in the prescriptions can be made. 

For More Information on Polypharmacy

Express Scripts members can find more information on polypharmacy – and download selected chapters of Knowing Your Medications: A Guide to Becoming an Informed Patient – by logging into their member account.

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