Science- If you've heard the term "polypharmacy" used to talk about medication recently, you're not alone.
- But what is it, and are there risks?
The term "polypharmacy" seems to be getting a lot of attention these days. Maybe you heard it referenced in the news in a story about teen mental-health treatment. Perhaps you came across it when reading up on prescription drug shortages. Or maybe your primary-care provider mentioned polypharmacy in a word of caution about the medications that you've been prescribed.
According to Google Trends, searches for "polypharmacy" are up significantly over the past several months. That tells us that the term is approaching buzzword status — and that a lot of people don't know what it means.
Despite how it sounds, polypharmacy is actually not the practice of hitting up a bunch of different pharmacies to get multiple prescriptions filled. Heidi Hwang, a licensed pharmacist and the director of clinical services for UnitedRx, explains that polypharmacy is simply a medical term used to describe being on multiple medications. People with complex medical conditions, people who use prescription medication for mental-health conditions, and people 65 and older run into this most often.
But the significance of polypharmacy is a little harder to explain. The United States is in the midst of an increase in chronic health diagnoses, a mental-health crisis in minors, and an aging population. That means that the number of people who are on multiple prescription medications continues to climb. People who use several prescription drugs at once to manage their health may be at a higher risk of drug side effects, falls, and longer hospital stays, which makes polypharmacy an issue providers are concerned about.
The US is also experiencing ongoing hiccups in its prescription-drug supply chain. This means drug shortages, and with them, increases in the consumer behavior known as "pharmacy shopping." This mix of multiple prescribers, multiple medications, and multiple drug-pickup points can lead to problems for patients down the line.
Insider spoke with two experts about what to know and how to stay safe when it comes to fulfilling multiple prescription medications.
What is polypharmacy?
A 2017 systematic review of definitions published in BMC Geriatrics tried to establish a baseline definition of the term "polypharmacy." That study's authors concluded that the medical community was not in complete alignment over how many prescriptions would meet the criteria to be considered polypharmacy. More recently, a 2019 article published in the American Family Physician defined polypharmacy as the regular use of five or more prescribed medications.
Of course, there are plenty of instances when taking multiple prescriptions can be perfectly fine, when medical providers are aware of all medications being taken as well as possible interactions. Appropriate polypharmacy combines the right drugs in the right doses to manage symptoms. Taking a combination of prescription drugs only becomes a problem when the risks begin to outweigh the benefits.
Dr. Laura Purdy, is a hospitalist and family-medicine practitioner based in Nashville, Tennessee, and medically licensed in all 50 states. Purdy said that it isn't uncommon for people to end up in situations where they have a long list of medications from multiple prescribers. Sometimes the same drug will be double prescribed by different providers. And once someone is on a drug to manage a long-term condition, there's no built-in off-ramp for de-prescribing it.
This can happen when people are in the hospital or an inpatient setting, according to Purdy. Providers only have access to the information that you give them, and care providers can't talk about your care without your express, written consent. Unless a hospital is able to communicate with other healthcare providers in your life, they can only see your medical records by requesting to have them faxed over. Purdy said the process can take weeks, and by the time it's completed, a patient may no longer be hospitalized.
That means doctors have to write prescriptions based primarily on information from the patient, which can present obvious problems. "Let's face it — if you're sick, if you're hurting, if you need surgery or are in the emergency room, you might not even remember or be physically capable of telling us what medications you are taking," Purdy said. And when the dust of an emergency clears, patients may leave with a stack of prescriptions in hand, some of which may be contraindicated to what's already in their home medicine cabinet.
Hwang said that pharmacies are supposed flag drugs that shouldn't be taken together. But here, too, the system isn't always efficient for patient protection. Pharmacists don't have access to records from pharmacies outside of their network, nor can they view your full medical history from all of your providers. Poorly updated medical records and automated-refill services at pharmacies can make the problem worse.
The only institution that has access to your full prescription history is often your insurance company, Purdy said — not the fail-safe you might hope for when it comes to staying safe from overmedicating.
What are the risks of polypharmacy?
The risks associated with polypharmacy are real, and researchers are starting to understand them better. But these risks look a little different depending on your age and the type of health conditions you have.
According to StatPearls, people 65 and older face the most serious complications from polypharmacy. Adverse drug events account for up to 28% of emergency-room visits for this demographic. Multiple drug interactions have been linked to increased risk of accidental falls and fractures; when you're taking two or more drugs that have the same possible side effects, the chance you'll experience them increases. Drugs used together — especially cardiovascular medications — can impact your body differently than if they were used alone, in what's called a "drug-drug" interaction.
Mental-health medications can also have drug-drug interactions, so it's essential to communicate with your prescriber about any medication you are taking for mental-health-symptom management.
There's also a phenomenon called prescription cascade. This refers to when a new symptom crops up as a side effect of a drug that you're taking — only your prescribing doctor interprets that symptom as a new health condition that needs to be treated. Prescription cascade results in more medication being prescribed to treat side effects of other drugs you're taking.
How do you prevent inappropriate polypharmacy?
Having a preferred pharmacy can cut down on your risk of running into a harmful drug interaction. Hwang said that a pharmacist will have a running list of medications you've picked up before that stays in their system. Any newly prescribed medication is supposed to trip an alert for the pharmacist if it can interact with something else you're already taking.
But again, ongoing drug shortages can make pharmacist loyalty a challenge. These types of shortages are nothing new; the FDA has long had to keep an updated list of drugs that are currently difficult to stock. When the medication people need isn't at their pharmacy of choice, most start calling around to see where they can get it. From a consumer perspective, this makes sense — it's what you would do with any other type of product.
But medicine isn't just any product, and pharmacy shopping can mean you aren't getting critical information about the drug you've been prescribed. If you do visit a different pharmacy, Hwang said it's important to make good use of the pharmacist's consultation window.
"Pharmacists are required to counsel. Any new prescription, a pharmacist is required to educate the patient on. If it's a new pharmacy, tell them you typically don't go there, and tell them about other medications you are on," she said. Don't forget to disclose over-the-counter supplements like vitamins and pain relievers in those conversations, too.
Any doctors who are a part of your care team should also be made aware of changes in prescriptions, negative side effects, supplements you are trying, or new diagnoses — and yes, that includes any mental-health providers. When you get a new prescription from one provider, call your other providers to check it against your existing prescription regimen and ask about possible interactions.
In addition to asking questions, Purdy recommends keeping your own list of medications, their dosages, and the conditions that you take them for. She says you should also give a copy of that list to your legally appointed next of kin, in case of an emergency. If you end up in a situation where you aren't able to communicate your prescription regimen, having this type of documentation should give prescribing doctors the information that they need.
It's also possible that the days of harmful polypharmacy combinations are numbered. Nursing-home facilities, where residents are often on seven or more medications, have begun to use clinical tools — like the Beers criteria — for regularly assessing residents' prescriptions and de-prescribing medications that are no longer indicated.
Purdy is hopeful that medical innovations will soon find a solution to polypharmacy. "As a healthcare industry, we have a duty. We are obligated to come up with a better solution for our patients. It should not be your responsibility. We should do that for you. And I hope that in the next decade, we can come up with systems and processes that don't involve fax machines," she said.