ConditionWhole body & general
Polypharmacy (Taking Multiple Medicines)
Polypharmacy is the regular use of multiple medicines, usually defined as five or more, including prescription drugs, over-the-counter medicines and supplements. It is common in older adults and people with several long-term conditions, and is often appropriate. But the more medicines someone takes, the higher the risk of side effects, drug interactions, falls, confusion, kidney problems and hospital admission. A regular, structured medicine review, and stopping medicines that no longer help (deprescribing), reduces these risks.
Also called: Multiple medication use, taking many medicines, problematic polypharmacy, medication burden
At a glance
- What it is
- Regular use of many medicines, commonly five or more.
- Who is affected
- Roughly 4 in 10 US adults over 65 take five or more prescription medicines.
- Main risks
- Side effects, interactions, falls, confusion, kidney injury, bleeding, hospital admission.
- Warning signs
- New dizziness, drowsiness, confusion, falls, constipation, poor appetite or incontinence.
- Solution
- Regular medicine reviews with a doctor or pharmacist and careful deprescribing.
- Key tools
- An up-to-date medicine list, one pharmacy, Beers Criteria and STOPP/START checks.
When to get help
Call 911 or go to the ER
- Sudden confusion, extreme drowsiness, fainting or seizures after a medicine change: call 911 or your local emergency number
- Vomiting blood, black stools or heavy bleeding while taking blood thinners, aspirin or NSAIDs
- Agitation, high temperature, sweating, muscle twitching and diarrhea after starting or combining serotonin medicines (possible serotonin syndrome)
- Swelling of the lips, tongue or throat, or difficulty breathing after a new medicine
See a doctor within a day or two
- A fall, or new unsteadiness or dizziness on standing
- New confusion, hallucinations or memory change developing over days
- Very low or very high blood sugar in someone taking diabetes medicines
- Much less urine, swollen legs or extreme tiredness
Book a routine appointment
- Taking five or more medicines without a review in the past year
- Not sure why you take a medicine, or having trouble keeping track of doses
- Side effects such as constipation, dry mouth, poor appetite, sleepiness or low mood
- Seeing several specialists who each prescribe medicines
Why polypharmacy happens
- Multiple long-term conditions: each guideline recommends several medicines.
- Prescribing cascades: a side effect is mistaken for a new condition and treated with another medicine (for example, ankle swelling from a calcium channel blocker treated with a diuretic).
- Several prescribers who do not see each other's lists.
- Medicines continued past their purpose, such as acid reducers after a short course.
- Over-the-counter medicines and supplements that are not mentioned to doctors.
Polypharmacy can be appropriate, when every medicine has a clear benefit, or problematic, when the harms outweigh the benefits.
Risks of polypharmacy
Side effects and interactions
Each added medicine increases the chance of side effects and interactions. Older adults are more sensitive because of changes in kidney and liver function, body composition and brain sensitivity.
| Problem | Common culprits |
|---|---|
| Falls and fractures | Sleeping pills, benzodiazepines, antidepressants, antipsychotics, blood pressure medicines, opioids |
| Confusion and delirium | Anticholinergics (some antihistamines, bladder medicines), sedatives, opioids, steroids |
| Bleeding | Blood thinners combined with aspirin, NSAIDs or some supplements (such as fish oil, ginkgo) |
| Acute kidney injury | NSAIDs with ACE inhibitors or ARBs and diuretics ("triple whammy") |
| Low blood sugar | Insulin and sulfonylureas, especially with poor intake |
| Serotonin syndrome | Combining antidepressants, tramadol, triptans, some cough medicines |
| Constipation | Opioids, anticholinergics, iron, calcium channel blockers |
Other consequences
- Falls and fractures
- Reduced adherence when regimens are complex
- Cognitive decline linked to long-term anticholinergic burden
- Hospital admissions: adverse drug events are a leading cause in older adults
- Cost and treatment burden
Who is at highest risk
- adults 65 and older
- people with kidney or liver disease
- people with dementia or frailty (frailty syndrome)
- people living in care homes
- people recently discharged from hospital
- people seeing multiple specialists or using multiple pharmacies
How a medicine review works
A doctor or pharmacist goes through every medicine, ideally with the actual bottles ("brown bag review"):
- List everything: prescriptions, over-the-counter medicines, vitamins, herbal products and eye drops.
- Check each medicine: Why was it started? Is it still needed? Is the dose right for kidney function and age? Is it working?
- Look for interactions and duplications.
- Use screening tools such as the AGS Beers Criteria and STOPP/START.
- Consider goals: what matters most to the person, life expectancy and how long a medicine takes to give benefit.
- Make a plan to stop, reduce, switch or add medicines, one change at a time, with follow-up.
Deprescribing
Deprescribing is the planned, supervised reduction or stopping of medicines that may be causing harm or are no longer needed. Common examples:
- tapering long-term benzodiazepines and sleeping pills
- stopping proton pump inhibitors no longer indicated
- relaxing tight blood sugar or blood pressure targets in frail older adults
- stopping statins or aspirin in some people near the end of life
- reducing anticholinergic medicines
Do not stop medicines on your own. Some, such as beta-blockers, antidepressants, steroids, benzodiazepines and anti-seizure medicines, can cause withdrawal or rebound effects if stopped suddenly.
Tips to take medicines safely
- Keep an up-to-date list of all medicines and doses, and bring it to every appointment.
- Use one pharmacy so interactions are checked.
- Ask why each medicine is prescribed, how long to take it and what side effects to watch for.
- Tell every doctor about supplements and over-the-counter medicines.
- Use a pill organizer, blister packs or reminder apps.
- Ask for a medicine review at least once a year, and after any hospital stay.
- Check with a pharmacist before starting any new over-the-counter medicine.
Frequently asked questions
What is polypharmacy?
Polypharmacy means regularly taking multiple medicines, usually five or more, including prescription and over-the-counter medicines and supplements. It is common in older adults with several health conditions. It is not always harmful, but it increases the risk of side effects and interactions.
Why is polypharmacy a problem in the elderly?
Older adults process medicines more slowly through the liver and kidneys and are more sensitive to side effects. Multiple medicines raise the risk of falls, confusion, bleeding, kidney injury and hospital admission. Regular medicine reviews help reduce these risks.
What is deprescribing?
Deprescribing is the careful, supervised process of reducing or stopping medicines that are no longer needed or may be causing more harm than good. It is done gradually, one medicine at a time, with monitoring. Never stop a medicine without speaking to your doctor first.
How can I reduce the number of medicines I take?
Ask your doctor or pharmacist for a full medicine review. Bring all your medicines, including supplements. Together you can identify medicines that are no longer needed, duplicates and those causing side effects, and make a safe plan to stop or reduce them.
Sources
This guide was written from current patient and clinical guidance, including:
- American Geriatrics Society: Beers Criteria for potentially inappropriate medication use in older adults
- World Health Organization: Medication safety in polypharmacy
- NICE: Medicines optimisation guideline (NG5)
- National Institute on Aging: Safe use of medicines for older adults
- US Food and Drug Administration: Drug interactions, what you should know