Every time I see a new patient, I like to get a thorough review of their medication list, especially if they are older than 65. Several times I have had the experience where a patient tells me: “my previous doctor gave me Drug A for my complaint, and Drug B for the side effect of Drug A, and Drug C for the side effect of Drug B…” and the list continues on and on like a chain of trains.
Polypharmacy is a term used to describe the situation where a patient is prescribed a multiple and alarming or unnecessary number of uncoordinated medications (prescriptions and over-the-counter). Polypharmacy is most common in the elderly, affecting about 40% of older adults living in their own homes.
Polypharmacy often occurs because the patient may be under the care of multiple physicians without having a primary doctor who coordinates all their health care. A person sees three different doctors and gets three different prescriptions. These prescriptions may interact with each other, causing side effects (sometimes dangerous) or they may work against each other, eliminating the benefit of the medication.
The good news is that there are multiple resources available to check your medication list for possible interactions and side effects. Here are some ideas to avoid interactions if you find you (or someone you love) has a polypharmacy situation:
- Keep a list. Bring a list of all your current medications including vitamins and over-the-counter items to all of your appointments and show it to your care providers. Ask them to check the list for any possible complications and remember to also ask if any of your symptoms might really be side effects.
- Go online. There are many websites you can check to see if there are potential problems in your polypharmacy regimen. To learn detailed information about a medication, go to Drugs.com and search their drug index at http://www.drugs.com/drug_information.html. This site will also help you look for potential drug interactions.
- Appoint a lead physician. Ask a family practitioner, internist or a geriatrician to be your “lead physician.” As part of this role, that doctor will evaluate your care from all your other doctors, review your medications, and make phone calls to coordinate care when necessary. Sometimes all you need to do is to let a doctor know that you would like this level of involvement in your care.
- Ask your pharmacist. Pharmacists are trained to look for drug interactions and other problems – but they can only do that if they have all your information. Hand them your polypharmacy list and ask them to look it over. This is especially important if you get your medications at more than one pharmacy, as all the information won’t be in one place.
Medications work wonderfully if taken and managed appropriately. It is very important to have a primary care doctor to coordinate your care, especially if you have multiple chronic medical conditions and other specialty physicians involved in your health care.
Haider SI, Johnell K, Thorslund M, Fastbom J (2007). “Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992 – 2002”. International Journal of Clinical Pharmacology and Therapeutics 45 (12): 643–653.