By Dr. Sk Sabir Rahaman, MBBS, MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD
🩺 What is Polypharmacy?
Polypharmacy means the use of multiple medications by a single patient — including prescription drugs, over-the-counter medicines, and even herbal/home remedies.
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WHO definition: Use of “many drugs” or an “excessive number” of medications.
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Numerical definition: Most commonly, ≥5 concurrent medicines.
👉 While sometimes necessary, polypharmacy can become irrational and harmful if not carefully monitored.
👴 Who is Most Affected?
The elderly are at highest risk due to:
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Multiple chronic diseases (DM, HTN, CAD, hypothyroidism, arthritis)
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Multiple specialists prescribing without coordination
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Age-related changes in how drugs are absorbed, metabolized, and eliminated
⚠️ Why Does Polypharmacy Happen?
| Cause | Description |
|---|---|
| Multimorbidity | One patient, many diseases → many drugs |
| Prescriber-related | Inappropriate initiation, no periodic review |
| Multiple doctors | Lack of coordination between providers |
| Transitions of care | Drug changes during admission/discharge |
| Prescribing cascade | Treating drug side effects with more drugs |
| Self-medication | OTC, herbal remedies not reported |
💡 Example:
NSAID → Gastric irritation → PPI → ↓Mg²⁺ → Leg cramps → Diuretic stopped → Electrolyte imbalance → Falls.
🔎 Types of Polypharmacy
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Appropriate: All drugs justified with favorable benefit–risk ratio.
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Inappropriate: Unnecessary, ineffective, or harmful drugs.
🚨 Consequences of Polypharmacy
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Adverse Drug Reactions (ADRs):
≥5 drugs → ~58% ADR risk
≥7 drugs → ~82% ADR risk -
Drug–drug interactions: Higher in elderly, renal/liver impairment.
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Poor adherence: Confusing regimens → missed doses/errors.
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Reduced quality of life: Fatigue, confusion, constipation, falls.
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Economic burden: Costly meds, lab tests, re-hospitalizations.
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Distrust in doctors: Failures can erode patient confidence.
✅ How to Prevent & Manage Polypharmacy
1. Screening Tools for Medication Review
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Beers Criteria: Avoid high-risk meds in elderly.
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STOPP: What to STOP.
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START: What to START.
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MAI: Appropriateness check.
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ARMOR: Assess–Review–Minimize–Optimize–Reassess.
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Deprescribing apps/tools: Medstopper, Deprescribing.org
2. SAIL Technique (Simplify Prescribing)
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S – Simplify dosing schedule
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A – Avoid high-risk drugs
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I – Indication must be justified
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L – List all medications clearly
3. TIDE Technique (Patient-Centered Approach)
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T – Time: spend enough consultation time
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I – Individualize by age, renal/liver function
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D – Detect drug interactions
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E – Educate patient & caregivers
4. Medication Reconciliation (During Transitions)
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Review patient’s pre-admission drugs
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Compare with new discharge prescriptions
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Adjust, reconcile & educate (e.g., “Brown Bag Review”)
5. Deprescribing (The Key Strategy)
A structured, supervised process to reduce or stop unnecessary drugs.
Steps:
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Review all meds
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Identify drugs without indication
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Assess benefit vs. harm
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Taper/stop gradually
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Monitor withdrawal or symptom return
Priority: Stop sedatives, anticholinergics, or duplicate agents.
6. Role of Clinical Pharmacologists
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Review complex prescriptions
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Optimize drug therapy
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Reduce ADRs & healthcare costs
💡 Fun Fact: India’s first Medication Reconciliation OPD was started at Seth Sukhlal Karnani Memorial Hospital (STM), Kolkata.
7. Use of AI & Digital Tools
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Interaction checkers: Identify DDIs in real-time
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Algorithms: Suggest safer alternatives
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Apps: Deprescribing.org, Medstopper
🌍 Global Initiatives on Safe Polypharmacy
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OPERAM: Prevent avoidable hospitalizations in elderly
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PRIMA-eDS: E-decision support for safer prescribing
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SIMPATHY: System-level innovations in polypharmacy care
🏁 Conclusion
Polypharmacy is not always wrong — but irrational polypharmacy is dangerous.
👉 Safe prescribing demands:
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Regular medication review
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Evidence-based tools
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Interdisciplinary teamwork
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Patient education
💡 Key Takeaway:
“Every drug must have a reason — and every reason must be reviewed regularly.”
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