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Polypharmacy: A Cautionary Tale of Taking Too Many Prescription Drugs

Tracking prescription drug use from 1999 to 2012 through a large national survey, Harvard researchers reported that 39 percent of those over age 65 now use five or more medications— a 70 percent increase over the 12 years tracking period.

“Polypharmacy” is the term for prescribing patients five or more medications at the same time (even if all are given for legitimate reasons).

This often happens when a person has many chronic diseases, such as diabetes, high blood pressure and heart disease, each requiring long-term treatment with medications.

What’s the Problem?

First, drugs are chemicals that can interact with one another with the potential to cause all kinds of complications (versus if you take just one medication).

Polypharmacy contributes to higher rates of hospitalizations and death, and higher costs.

For example, an anti-inflammatory medication like Ibuprofen (Advil, Motrin, Midol, Nuprin), may increase blood pressure and worsen kidney function. Therefore they should not be used by persons with high blood pressure or kidney problems.

Next, as we age, the kidneys and liver become less efficient in passing medications out of the body. The lingering drugs can magnifying their effects as well as have side effects.

Polypharmacy contributes to higher rates of hospitalizations and death, and higher costs.

Should You Be Prescribed Fewer Drugs?

Some people outgrow their medication. They change their lifestyle (ex. diet, physical activity, and weight loss) and subsequently may no longer need medications for diabetes, cholesterol or high blood pressure.

But they keep taking them, because no one told them to stop.

To ‘deprescribe’ a drug is not as simple as saying “stop”. It’s a process requiring caution and skill by your doctor.

Simple errors can occur, too. Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, recalled asking a patient to bring in every pill he took for a so-called ‘brown bag review’. He learned that the man had accumulated four or five bottles of the same drug without realizing it, and was ingesting several times the recommended dose.

De-Prescribing: A Brown Bag Review

Always keep an accurate and updated list of medications you are taking including over-the-counter drugs, herbal products, and supplements. Give your doctors each a copy. (See our free download form below.)

Periodically ask your physicians or pharmacist for your own ‘brown bag review’. Discuss whether to continue or change any of your regimens. Ask about:

▪ any medicines you no longer need?
▪ any medications you can do without?
▪ if a lower dose would work for any of your medicines?
▪ if any of your medications might interact with any another?
▪ any non-pharmacologic alternatives?

If your doctor agrees to ‘de-subscribe’ a medication, realize it isn’t as simple as saying “stop” taking it. It’s a process requiring caution and skill by your doctor. (Afterwards, remember to update your list of medications.)

“We spend an awful lot of money and effort trying to figure out when to start medications and shockingly little on when to stop.”

Dr. Caleb Alexander, Johns Hopkins Center for Drug Safety and Effectiveness

Free Download: Keep an Inventory List of Your Medications

As a service to atrial fibrillation patients, we offer Free Reports, Worksheets and Downloads of our own worksheets and articles and useful free services or downloads from others serving the atrial fibrillation community.

Inventory List of Your Medications: We want to help you keep your doctor and other healthcare providers up-to-date on all the medications you are taking by using this Medications List from Alere.

Download and use to help you keep track of everything (including over-the-counter drugs, vitamins, herbs and mineral supplements, too). Remember to save the PDF to your hard drive.

Because your medications will change over time, print several copies of the blank form so you will always have a clean copy ready to use. (Keep in your A-Fib file or binder.) Give a copy to each of your doctors or other medical healthcare providers.

Resources for this article
• Kantor ED, et al. Trends in Prescription Drug Use Among Adults in the United States From 1999-2012. JAMA. 2015;314(17):1818–1830. doi:10.1001/jama.2015.13766

• Onder G, Marengoni A. Polypharmacy. JAMA. 2017;318(17):1728. doi:10.1001/jama.2017.15764 JAMA. 2017; https://jamanetwork.com/journals/jama/fullarticle/2661582

• Span, P. The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills. New York Times, April 26, 2016. URL: https://www.nytimes.com/2016/04/26/health/the-dangers-of-polypharmacy-the-ever-mounting-pile-of-pills.html

• Mishori, R. Why doctors should be prescribing less drugs. The Independent. 30 January 2017. http://www.independent.co.uk/life-style/health-and-families/healthy-living/prescribing-drugs-is-good-so-is-deprescribing-a7552971.html

• Jou J, Johnson PJ. Non-disclosure of complementary and alternative medicine (CAM) use to usual care providers: Findings from the 2012 National Health Interview Survey. JAMA Intern Med. 2016.Apr;176(4):545-6. doi: 10.1001/jamainternmed.2015.8593. PubMed PMID: 26999670.

• Qato DM, et al. Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016 Apr;176(4):473-82. doi:10.1001/jamainternmed.2015.8581.

 

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