Are you taking too many medications?

How many medications have you been prescribed and are currently taking?

If you are currently taking five or more drugs concomitantly, then you are experiencing what research studies have defined as polypharmacy. Polypharmacy, or being on five drugs at the same time, has been linked to a higher risk of drug-related problems and poor health outcomes.

However, polypharmacy has been found to be more complex than just the number of medications one takes. Other criteria for polypharmacy include taking a medication with no true indication, using two therapeutic equivalent drugs to treat the same illness, using two medications that interact with one another, taking an inappropriate dosage of a medications, or utilizing other medications to treat adverse drug reactions that are occurring.

There are two types of polypharmacy: therapeutic polypharmacy and contra-therapeutic polypharmacy.

Therapeutic polypharmacy occurs when multiple drug regimens are carefully monitored by health care providers because they are necessary to treat a number of conditions. Thus a therapeutic goal is achieved. Contra-therapeutic polypharmacy occurs when an individual experiences an adverse effect to a drug regimen, yet is not monitored. This proves detrimental to the patient when taking several medications over an extended period of time, especially if they are of high dosages without being followed up closely.

Are you taking the right medicine the right way?

The Beers Criteria, is able to point out which medications may be inappropriately utilized in the older adult population. The list was originally developed in 1991 and then revised in 1997, and most recently in 2012 to point out which medications are to be avoided in older adults, rather it is independent of disease or due to a previous medical diagnosis.

The community must be aware of the risks that polypharmacy brings to individuals, especially older adults. Researchers have found that greater than 75 percent of adverse drug reactions that resulted in a hospitalization were related to a known pharmacological agent. The reasons specifically included inadequate monitoring, inappropriate prescription or lack of patient education and compliance with the regimen. Interestingly, a patient who is taking two medications only has a 6 percent risk of an adverse drug reaction. However, this risk rises to 50 percent when 5 medications are taken at the same time, and is a 100 percent risk when 8 medications are prescribed.

These adverse drug reactions are at greatest risk in the older adult population due to the normal changes that occur in the aging body. The biggest changes are decreased function of the kidney and liver, which usually play the role of excreting medications after they have been used. As a result, medication levels can rise to unintended levels in the older adult and can cause atypical symptoms of an adverse drug reaction. Examples of such geriatric syndromes can include confusion, falls, incontinence, urinary retention and general uneasiness. Oftentimes, a physician may turn around and prescribe anther medication to treat such symptoms. But is this the answer?

Clearly, this is not the solution. If you are older than 65 years of age or have loved one who is, and have a drug regimen consisting of five medications or more, be sure to have your pharmacist and physician review your medications to see if a therapeutic or contra-therapeutic polypharmacy is occurring.

Make sure a medication review or medication reconciliation occurs every time a new medication is added or you begin a new supplement (such as a vitamin or herb). It may save you an adverse drug reaction or an unplanned hospitalization!

Tamara Brown is a nursing faculty member at a local university and has been in the nursing profession for seven years. Email tamarabrown1987@gmail.com.