Defining Polypharmacy and Explaining its Risks
Polypharmacy is defined as the concurrent use of multiple medications by a patient to treat multiple coexisting conditions. Typically, a polypharmacy patient is taking at least 5 or more different medications a day. This can be dangerous for all patients, but even more so in the elderly.
As a caregiver, you can help your loved one to safely manage their medications. Below is some information about potential risks of polypharmacy, steps you can take as a caregiver to prevent this issue, and ways to resolve this if you or your loved one are currently experiencing polypharmacy problems.
Several risks are associated with polypharmacy issues. The most common risks include adverse drug interactions, increased falls and drug toxicity.
Adverse Drug Interactions.
This can occur when multiple prescribed medications, herbal supplements and over-the-counter drugs are being used simultaneously. Often this happens because the medications your loved one is taking may have been prescribed by several different doctors. One physician may prescribe a medication that interacts negatively with a medication prescribed by another doctor, if they are not given accurate, up-to-date information. Although communication between doctors is better now than it has been in the past, thanks to technology such as electronic medical records, there are still occasions when this information is not passed on from one doctor to another.
This can also occur if your loved one does not inform their doctor of the herbal supplements or over-the-counter medications that he/she is taking. These combinations can potentially cause adverse drug reactions, which can be avoided if the doctors have all the information they need from the beginning.
There are certain drugs that can be used for common symptoms of stomach and urinary problems, such as Diuretics (Lasix, Bumex), Benzodiazepine derivatives (Lorazepam, Diazepam, etc.), and Anticholinergics (Benadryl, Seroquel, Parkinson’s medications, etc.) that can actually increase the risk of falls.
If your loved one is forgetful, he/she may not be taking their medications at the correct times or in the correct dosages, which could potentially lead to drug toxicity. Drug toxicity occurs when a person has accumulated too much of a drug in their bloodstream, which leads to adverse effects on the body and could potentially be fatal.
Steps the caregiver can take to avoid polypharmacy:
- Create a medication list which includes all herbs, supplements, over-the-counter medications, and prescribed medications. Keep the list with you at all times and make sure to include the dosages and frequencies.
- Bring the medication list and the medicine bottles to every doctor’s appointment. If anything changes at the appointment, update the list immediately.
- Take responsibility to inform each doctor or healthcare professional who is involved in your loved one’s care of all the medications that he/she is taking.
- Use only one pharmacy to fill prescriptions.
- Learn about the medications and what they are used for. Read the labels as well, which could inform you of any possible drug interactions.
- Educate yourself and your loved one about any potential side effects for each medication. Keep an eye out for any of these side effects and notify the doctor right away if you see any indication of these. In some severe cases, it may be recommended that your loved one be admitted to an acute hospital, psychiatric hospital or rehabilitation facility where they can safely taper them off of their medications and then start from scratch under close medical supervision.
- Try to avoid combination products, such as cold/flu formulas, that treat multiple symptoms. Ask your pharmacist to help you find a product just for the symptoms your loved one is experiencing – not for every possible symptom.
- Never take a new drug without asking your pharmacist about its side effects and interactions with other drugs.
- Help your loved one to set up medication in a pill box that clearly indicates which pills to take at a specific time each day. You can also purchase an automatic pill dispenser, if needed.
If you are currently experiencing a polypharmacy issue, here are some steps you can take to resolve it:
- Request a medication review with the physician. See if there are any medications that are no longer needed or dosages that can be reduced.
- Ask your pharmacist to run the medication list through a drug interactions database to identify possible problems.
- If you were recently discharged from a hospital, make an appointment to see your primary care physician right away and review any new medications.
- If your doctor discontinues a medication from the list, remove that medication from your home and discard appropriately.
- Appropriately discard all expired medications.
By Chrissy Schuster, LMSW, CCM