Polypharmacy Problems: How many drugs are too many?

Polypharmacy Problems: How many drugs are too many?

Statistics show that 21.8 percent of Americans are using three or more prescription drugs daily in the past 30 days and that 10.7 percent of Americans are using five or more prescription drugs per day in that time frame. Experts say that more than 100,000+ DDIs (drug-drug interactions) are possible, even with seemingly innocuous drugs, creating the possibility of dangerous cross-reactions.

Polypharmacy, the use of a large number of medications, usually five or more, is a consequence of having several underlying medical conditions. Thus, it is much more common in elderly patients.  Harvard researchers recently reported that 39 percent of those over age 65 now use five or more medications a day — a 70 percent increase in polypharmacy over 12 years.  Some of these medications may be questioned or unnecessary. 

Patients may have several co-existing medical conditions or may require combinations of two to three different medications for the same condition.  Some drugs are prescribed for symptomatic relief or to treat the adverse effects of another drug. Many patients see different physicians for their medical problems, and specialists may not be aware of other drugs the patient is taking. Often, a primary care physician should be coordinating the use of multiple medications.

When polypharmacy causes adverse effects, it may require emergency room visits or hospitalizations. Drug interactions may hurt patients, based on the combination of one drug with another medication.  Initial testing during drug development may not reveal all of the possibilities of such interactions.

Dr. Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness, cited an example: “A cardiologist puts someone on good, evidence-based medications for his heart. An endocrinologist does the same for his bones. The patient uses an over-the-counter reflux drug and takes a daily aspirin or a zinc supplement and fish oil capsules. Pretty soon, you have an 82-year-old man who’s on 14 medications.”

“We’re not paying attention to the interactions and safety of multiple medications,” said Dima Qato, the lead author of the JAMA Internal Medicine article (co-authored by Dr. Alexander) and a pharmacist and epidemiologist at the University of Illinois at Chicago. “This is a major public health problem.”

She cited the fact that people are taking over-the-counter supplements along with prescription drugs. Sometimes the combinations produce negative effects.

According to Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco, older people are more vulnerable to the complications of drug interactions. Because many have multiple chronic diseases, they take more drugs and increase the potential for threatening interactions. If a drug interaction makes a senior dizzy, he or she is more likely to fall and get hurt, he said.

“At the heart of the issue are doctors who, instead of referring patients to other appropriate healthcare providers, simply write multiple prescriptions to try to manage a patient’s symptoms,” said Stephanie Higashi, D.C., CEO of Health Atlast. “Often, these doctors don’t get to the cause of the patient’s problem, nor do they provide the patient with all the information needed to make an informed decision about their care.”

Dr. Higashi proposed alternative medicine or multispecialty medical groups as possible solutions. At the very least, doctors have to communicate with each other about the medications they prescribe to patients and inform patients about the dangers of combining supplements with those medications. Otherwise, the polypharmacy problems will get worse.

Ilene Schneider is the owner of Schneider the Writer (www.schneiderthewriter.com), a firm that provides communications for health care, high technology and service enterprises. She has edited or written for numerous technical publications, as well as serving as a publicist for various medical, biotechnology and pharmaceutical companies.

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