Dangers of Polypharmacy

Taking a lot of medications? You could experience higher health risks

By Deborah Jeanne Sergeant

Pharmacist David Dingman is the owner of The Medicine Place in Phoenix and Fulton.

People aged 60 to 64 take an average of 13 prescription medications, according to Georgetown’s Health Policy Institute.

That number rises to 20 by age 65.

But just taking five or more daily medications is what Jinjiao Wang, Ph.D., assistant professor of nursing at University of Rochester Medical Center, calls “polypharmacy.”

“Its danger is not because of the number, but the risk of potentially unnecessary or inappropriate medications that increases along with the number of medications one is taking,” Wang said.

Wang is co-editor-in-chief of the research journal JMIR Aging.

Unnecessary polypharmacy or inappropriate polypharmacy happens when a patient is prescribed a medication initially intended for a specific time period or for specific symptoms but the patient is still taking it even though the issue it should address is no longer present.

“That this ‘legacy’ medication may no longer be needed or, even worse, causing side effects,” Wang said.

Some patients take medication to treat side effects caused from other medication which providers may mistake as new symptoms.

Wang calls this phenomenon “prescribing cascade.”

This often happens with older adults who see multiple specialists. They may prescribe medication that the others don’t know about. Even with electronic medical records, if the patient sees providers associated with different health systems, that information may not be shared.

Jack Hess, pharmacist at Hannibal Pharmacy, calls it “polymedicating” when patients need more and more medication to take care of the side effects from other drugs. He believes that sometimes patients don’t ask providers for medications with fewer bothersome side effects.

“In today’s broken healthcare system, you have to be your own advocate,” Hess said. “Don’t take things for granted. Doctors have no time to communicate with each other or with the patients in front of them.”

As a result, patients may end up with medications they don’t really need or prescriptions that are contraindicated with other medications and cause further side effects.

Hess said he fills a prescription every 111 seconds on average which he attributes to the increase in unnecessary prescriptions.

“Build a personal relationship with the pharmacist; that’s the only way I know how,” Hess said.

Filling at only one pharmacy can provide oversight, as well as keeping all of the care providers up-to-date on all prescriptions, supplements and over-the-counter medicine.

“They can’t just call a random pharmacy to ask questions about their prescription,” Hess said. “I get that a lot. There’s the big issue with mail order pharmacies. You’re playing a dangerous game.”

Taking unneeded medication costs patients and insurance companies money. It also takes out of the drug supply medication that someone else may need and in some cases struggle to find. Unnecessary polypharmacy also taxes the patient’s body as it must process yet more prescriptions.

It’s also taxing on the patient. Swallowing numerous pills daily can cause pill fatigue. It can become troublesome to take them at the right time and in the right fashion, such as before breakfast, with food or at bedtime. Taking medication incorrectly can hamper its ability to work correctly and with more medications comes more chances to make mistakes.

Swallowing numerous pills increases risk for drug interactions.

Especially in older adults, polypharmacy can raise risk for side effects such as confusion, falls, loss of appetite, increased sedation and other contributors to hospitalization.

Part of the problem for excess prescription drug consumption, according to pharmacist David Dingman at The Medicine Place in Phoenix and Fulton, is that some people rush to take drugs, even when they don’t need them. “You have patients seeking medications for issues they perceive.”

Trying to address the certain issue at home first can sometimes resolve it instead of rushing off to the doctor or urgent care for minor problems.

Common problems like a head cold need only rest and fluids to improve, not antibiotics, which don’t even treat viruses. Overusing antibiotics leads to “super bugs” that resist antibiotics.

Dingman also promotes preventing chronic health issues and reducing the need for medication through positive lifestyle changes instead of letting things go and demanding a prescription to treat the symptoms.

“You have a 30-year smoker saying they can’t breathe during allergy season they end up on cadres of medication but stopping smoking will resolve 90% of their issues,” he offered as an example.

Dingman believes that over medicating is “bankrupting health systems” and may be causing underlying health problems that will crop up later.

He encourages patients to drink more water, exercise and eat a healthful diet. Many health issues could be prevented or improved with taking these measures.