Polypharmacy

Some people may need to take a large number of medicines, but there are instances where the use of some medicines may be unnecessary.

Good polypharmacy

This is where you have many illnesses or a complex medical condition that is being treated with more than one medicine, and where the potential benefits outweigh the potential harms. For example, a person with heart failure, high blood pressure and atrial fibrillation (irregular heart beat) will be prescribed a range of heart medicines, all of which are likely to improve their health.

Bad or problematic polypharmacy

This is where you are treated with many medicines, where one or more of these medicines has potential harms that outweigh the potential benefits. For example, you may no longer need the medicine, the medicine may adversely interact with another medicine or you may not receive the intended benefit of many treatments.

Reducing problematic polypharmacy improves safety and quality of life, while also reducing waste.

Polypharmacy usually happens when a person has many medical conditions and is receiving treatment for them. Polypharmacy is more common in older adults because this age group tends to have higher rates of ongoing illness and is usually prescribed more medications.

Other factors contributing to polypharmacy include the following:

• The discovery of a broad range of pharmaceuticals for a wide variety of conditions has helped many people. Unfortunately, this development has led to both overuse and inappropriate use of prescription medications.
• Sometimes prescribed medication can cause side effects, which may be interpreted as symptoms of another illness. The health provider then prescribes more medication to treat these symptoms, creating the potential for even more side effects. 
• The use of over-the-counter medication, complementary or alternative medicines such as herbal therapies, and vitamins and supplements is becoming increasingly popular.

The major concern of polypharmacy to a person is a much higher risk of adverse drug effects – the more medicines you take, the greater the chance of side effects. In older adults, polypharmacy has been associated with serious effects such as:

• increased falls and fractures
• dehydration and kidney problems
• delirium and confusion
• low blood glucose (hypoglycaemia)
• malnutrition.

Taking lots of medicines means that you have to remember to take all of them properly. This can be tedious especially when you're away from home or travelling. 

Medication reviews

Talk to your pharmacist, doctor or nurse about having a medication review. This involves your pharmacist, doctor or nurse gathering information about your medicines from you and your medical record. This information is used to check that you are taking the most appropriate medicines. You will also have the opportunity to ask questions about your medicines and raise any concerns you have.    

Get to know your medicines

• Learn your medications by name and what they are for.
• When you are prescribed new medication, ask your doctor:
  • what the medicine is for
  • how long you need to use it
  • whether there are other medicines or foods you should avoid while taking this medicine.  
• Make a list of all your medications, including pill strength and dose, as well as herbal products, vitamins, homeopathic remedies, supplements and over-the-counter drugs.
• Carry your medication list everywhere, and bring it to every doctor visit, along with the pill bottles.
• Update your medication list after every doctor visit.
• If you have more than one doctor, make sure each one knows what the other is prescribing.
• Read your medication labels – they may tip you off to possible drug interactions.
• Never take a new drug without asking your pharmacist about its side effects and interactions with other drugs. 

Read more on how to get to know your medicines.

Other things you can do

• Avoid combination medicines, ie, medications that contain more than one active ingredient, such as cold and cough formulas. 
• Use lifestyle measures whenever possible, either together with or instead of medications. 
  • If you have sleep problems, there are a number of lifestyle tips you can try, instead of using medication. Read about tips for sleep.  
  • For muscle sprains, use rest, ice, compression and elevation (R.I.C.E) together with pain relief.  

Older people taking lots of medicines (polypharmacy in older people)(external link) The Atlas of Healthcare Variation, NZ

Common questions to ask about the medicines you are taking
Medicines – safety tips
Medicines – tips to remember

1. Polypharmacy in primary care: Managing a clinical conundrum(external link) BPAC, NZ, 2014 
2. Polypharmacy in older people(external link) Health Quality & Safety Commission, NZ