Taking a multitude of prescription medications at a time is described as polypharmacy. More than five drugs administered by any route constitute too many drugs in a prescription, according to the World Health Organisation (WHO). This is a massive burde
n on patients, as it leads to a myriad of drug interactions, adverse drug events, medication non-adherence, reduced functional capacity, cognitive impairment, falls, urinary incontinence and poor nutrition, which all invariably lead to bad therapeutic outcome.
Polypharmacy is most prevalent amongst the elderly, hospital in-patients, and nursing home patients. The best interventions involve an inter-professional approach that often includes a clinical pharmacist.
Tracking prescription drug use from 1999 to 2012 through a large national survey, Harvard researchers reported that 39 percent of those over age 65 now use five or more medications, a 70 percent increase in polypharmacy over 12 years. It is therefore imperative that the pharmacist enlightens other members of the healthcare team, as well as the patients, on medicines and the complexities of prescribing and taking too many drugs.
Community pharmacists on the other hand, must not coerce patients into buying drugs with the aim of making sales alone. This leads us to an alternative definition of polypharmacy, which is the use of more medications than are medically necessary. For this definition, medications that are not indicated, not effective, or which constitute a therapeutic duplication would be considered polypharmacy. It is therefore imperative for pharmacists in the community practice to balance professionalism with business ethics by selling and dispensing only prescription medicines necessary for a patient’s condition.
Patients and families must ask their pharmacists for medicine use review services, where they bring all the drugs they use to discuss whether to change or continue certain drug regimens. I remember the case of a patient taking four different supplements, all containing calcium, without knowing. My timely intervention saved her from complications such as hardening of arteries which could be fatal.
Some drug combinations can spell trouble when prescribed, especially in the elderly. For instance, using aspirin as a painkiller, while using clopidogrel, could lead to severe bleeding through the blood-thinning effect. A combination of simvastatin and amlodipine should also be avoided in any prescription, as statins, along with their cholesterol-lowering properties, can cause muscle pain and weakness; amlodipine heightens that risk. A different blood pressure, drugs such as Lisinopril would be a safer choice.
One of the complications that arise as a result of polypharmacy includes devastating falls, leading to broken hips and head injuries, many of which account for preventable visits to emergency care, causing higher mortality risks overall.
Polypharmacy can be addressed on two fronts, which involve engaging healthcare providers and patients themselves. In meetings or gatherings involving any association of healthcare workers, discussions should be tailored towards weaning patients off dubious medications and educating them on the risks and benefits of the drugs being prescribed and dispensed by the doctor and pharmacist respectively. Information on how to manage multiple prescriptions should be discussed with patients.
The patient, or any caregiver close to the patient taking multiple medications, can combat potentially dangerous problems by keeping a list of all medications, including vitamins and over-the-counter items. On every hospital visit, ask the pharmacist to help check your list for any complications and remember to report all adverse drug reactions.
Ultimately, the best way to reduce polypharmacy is to overhaul our fragmented approach to healthcare. Team effort will bring about a radical change in overcoming polypharmacy as physicians, pharmacists and nurses must work together to reduce drug wastage, adverse drug reactions and bad therapeutic outcome.
By Ayodeji Oni
(Freelancing for Advantage Health Africa)