Taking multiple medications? You may need to scale back

NEW YORK – Around one in five adults between the ages of 40 and 79 is taking five or more prescription drugs, according to data from the United States’ Centers for Disease Control and Prevention. And the older patients are, the more likely it is they are taking even more medications.

But taking many medicines simultaneously, known among medical experts as polypharmacy, increases people’s risk of experiencing severe side effects and drug interactions, said Dr Nina Blachman, an associate professor of medicine and geriatrics at the New York University Grossman School of Medicine.

Studies show that taking multiple medications is associated with a faster decline in memory in some patients with mild cognitive impairment, and with a greater risk of falls among people with balance problems or weakened muscles. Certain combinations of drugs can also lead to excessive bleeding, dangerously low blood sugar or other serious complications that lead to hundreds of older adults being hospitalised every day.

While medicines can be critical for improving people’s quality of life, it is important to understand how patients end up taking too many drugs unnecessarily and when to ask for help trimming their prescription list.

As people age, they develop more health issues such as diabetes, heart disease, arthritis and high blood pressure, and end up being on more and more medications, Dr Blachman said. Many are never taken off the drugs they have been prescribed for years, even if they no longer need them or if there are newer formulations available that can treat different symptoms simultaneously.

Patients sometimes also see a variety of medical providers, each of whom may prescribe medication without necessarily communicating with one another.

Sometimes, medical professionals may prescribe drugs to treat the side effects of another medication, in what doctors refer to as a “prescription cascade”.

For example, people who take certain over-the-counter pain medicines called nonsteroidal anti-inflammatory drugs may experience an increase in blood pressure, which doctors may misdiagnose as a new ailment and prescribe calcium channel blockers as a treatment.

But in some people, these blood pressure drugs can lead to ankle swelling, which may then lead to a prescription for a diuretic to reduce fluid build-up in the body.

“So you end up just chasing side effects of one medication after the next,” Dr Blachman said.

Older patients may also be more likely to develop new or worse side effects to drugs because kidney and liver function can decline with age, making the body less able to filter out some medications, said Dr Barbara Farrell, a scientist with the Bruyere Research Institute in Ottawa, Ontario. This can lead to patients being prescribed more medications to treat those side effects.

While polypharmacy is most common in older people, younger adults and children, particularly those with complicated chronic conditions such as epilepsy, learning disorders or mental health issues, can also end up on many medications.

To further complicate matters, pharmacists and doctors do not always know how or when to safely help patients come off drugs, Dr Farrell said. But in recent years, she and other experts have pushed for more guidelines on tapering or stopping prescription drugs.

Ideally, doctors and pharmacists should do what is called medication reconciliation each time you see them, said Dr Kuldip Patel, senior associate chief pharmacy officer at Duke University Hospital in North Carolina.

To do this, his team reviews the list of medications people are taking whenever they are admitted to or discharged from the hospital. But that does not happen in every medical setting, he said.

Experts suggest asking a primary-care doctor or pharmacist to do a full medication review at least once a year. Many pharmacies offer such evaluations under free medication therapy management programmes.

Make a list of your medicines – including supplements and over-the-counter drugs – or grab all of your pill bottles and take them with you to the appointment, Dr Patel said.

But perhaps the best time to speak up about prescription use is before you start a new drug.

Ask your doctor questions such as “Am I experiencing a symptom that could be a side effect of a drug I’m taking?” or “Can I try to manage this symptom with lifestyle changes first?”

When you do need a medication, check if you can start with a lower dose, Dr Farrell said. Remind the doctor of medications you are taking and ask how the new drug will interact with them.

Lastly, ask how long you will need to take a medication and work on a plan with your doctor to stop taking it if needed. You should understand how your provider plans to help you taper off the drug, what withdrawal symptoms to watch for, and how to make sure the issue you were being treated for does not return.

“These are questions people should be asking even in their teens and 20s, when they’re being started on some of these medications,” Dr Farrell said. “Then, hopefully, someday we’ll be able to prevent people from getting to the point where they’re taking 25 medications all together.” NYTIMES