Polypharmacy and deprescribing
Polypharmacy is an increasing problem in a population, which gets older, is more obese and affected with more diabetes and subsequently cardiovascular problems (see earlier news item). In this short report polypharmacy is the excessive or unnessary use of medications. The polypill is one solution, predescribing is another one.
Polypharmacy has several possible consequences:
- Adverse drug effects such as nausea, confusion, bleeding
- Drug-drug interactions , when a medication changes the effect of other medications taken together
- Medication nonadherence
- Deceased mobility and falls
- Increased health care use, including visits to a clinic, an emergency department or hospitalization
- Higher costs both out-of-pocket and for the community
How can the risk of polypharmacy be decreased:
- Bring an up-to-date list of prescriptions and over-the-counter medications or take all medication bottles to each medical appointment and also report if you take dietary supplements, they may interact.
- Talk with a doctor or pharmacist before starting any over-the-counter medications or dietary supplements to be taken on a regular basis.
- When a new medication is recommended, ask the doctor or pharmacist how long you should expect to take it.
- Talk with a doctor or pharmacist if you are taking a medication longer than planned, to determine if it is still needed.
- Review with your doctor or pharmacist all medications that were prescribed after discharge from a hospital because some may be needed for only a limited time.
- If possible, obtain all medications from a single pharmacy to keep a good overview and to allow the pharmacist to verify that new medications are safe to take with current medications.
If you think you may be experiencing polypharmacy, schedule an appointment with your doctor specifically to discuss your medications. Talk with your doctor or pharmacist before making any medication charges.
What is deprescribing?
Deprescribing is the medically supervised process of decreasing or stopping medications that are no longer needed or may be causing harm. The benefits and risks of medications can change as people get older, so medications that have been taken for many years may need to be adjusted or even stopped. Sometimes an alternative medication that is safer or a nonmedication lifestyle may be recommended to manage a health condition. A doctor or pharmacist should advise patients how to stop a medication, including whether it needs to be slowly tapered off, and discuss symptoms that may develop after stopping medications. Deprescribing can benefit patients by decreasing medication side effects and drug interactions, reducing nonadherence to medications, lowering out-of-pocket and community costs, and improving health. Medications that have been stopped should be safely disposed of and not restarted without first talking to a doctor or pharmacist.
This short news item is taken from a JAMA patient page 2023; SE Vordenberg et al with slight modifications.
