How many prescriptions are too many?
There's no question that many medications -- like those that reduce blood pressure or cholesterol -- have saved lives and kept people healthier longer. But can you have too much of a good thing?
You can, and the problem is known as "polypharmacy." Two-thirds of older adults take five or more medications, which is the threshold for polypharmacy. These days, with complicated medical conditions, it's not uncommon for someone to be taking two or three times that.
Not all polypharmacy is a bad thing. There's something called "therapeutic polypharmacy," in which several drugs are provided in a coordinated effort to treat a specific condition, according to Pharmacy Times. It gave an example of digoxin, ACE inhibitors to relax veins and arteries, and a diuretic in the management of heart failure. It is the responsibility of the doctor and pharmacists to make sure these combinations are appropriate and effective.
The type of polypharmacy that is potentially harmful involves multiple drugs being taken for the same condition or drugs that have adverse reactions with other drugs. And the problem is becoming more widespread because patients are likely to see different specialists and obtain their medications from more than one source.
Pharmacy Times writes that, according to research, more than 75% of adverse drug reactions that require hospitalization are at least partly due to "inadequate monitoring, inappropriate prescribing, and lack of patient education and compliance." Research also indicates that the potential for negative drug interaction rises to 100% when eight or more medications are taken simultaneously, according to the journal.
Older individuals -- whether that's you or a loved one -- are particularly vulnerable. An analysis of Medicare data last year concluded: "Potentially inappropriate medication use among older adults is both common and costly."
It estimated that in 2018, 7.3 billion doses of potentially inappropriate medications were dispensed, the most common being protein pump inhibitors (such as Prilosec and Prevacid); benzodiazepines (Xanax and other drugs used to treat anxiety and sleeplessness); and tricyclic antidepressants (such as Amitriptyline and Amoxapine). The cost? More than $25 million.
Those psychoreactive drugs, which act on the central nervous system and affect brain function, are a particular concern in older adults. Several clients I've worked with have experienced dementia-like symptoms simply because of the medications they were taking. They should be monitored closely.
Fortunately, many health care providers recognize polypharmacy is a problem, and there is a relatively new movement known as "deprescribing." An association for long-term care facilities and post-acute caregivers has started a Drive to Deprescribe campaign to encourage their members to reduce polypharmacy.
But it won't be easy. Some patients are reluctant to give up drugs they've taken for years, even decades, and they may wonder if they're somehow being mistreated. Another barrier is our fragmented health care industry, in which a cardiologist and an endocrinologist may not know what each other is prescribing, and the primary care doctor doesn't want to step on their toes.
"There's a general bias toward doing things in medicine," said Dr. Ariel Green, a geriatrician and researcher at Johns Hopkins, told The New York Times. "If we prescribe something, that's seen as a positive action. If we stop something, or don't start it, that's not."
So, as I've written before, you have to be your own best friend when it comes to your health care. If there is a concern, always check with your doctor. Here are a few recommendations:
• Bring all of your medications or at least a list of them to every doctor's appointment, whether it's with your primary care physician or a specialist. If you are responsible for the care of an elderly family member, this is particularly important.
• Ask your primary care doctor or a trusted pharmacist to review your medications to ensure they're appropriate for you to be taking. Ask if there are some you can stop taking. A patient advocate with a background in pharmacy can help you and your health care providers take a more integrated approach to your medications.
• If a doctor wants to prescribe a new medication, besides researching your out-of-pocket costs, take a look at what it's supposed to do and ask your doctor if it may react badly with something else you're taking.
• Watch for drug reactions, particularly if you're caring for someone else. This could be anything from a rash to dementia-like symptoms. If you see behavioral changes, consult your doctor immediately.
You can help in the campaign against polypharmacy. Not only will you be saving money, you could also be improving your well-being.
• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). She is offering a free, 30-minute phone consultation by calling (312) 788-2640 to make an appointment.