Combining Medications Not Always Dangerous

polypharm

Concern is growing about the increasing numbers of medications prescribed to elderly patients. For all the jokes about old people taking large numbers of pills, the use of multiple medications—which may interact with each other in unexpected, unpredictable, or dangerous ways—is a subject that worries health care providers as they work to provide complete care to patients who may have multiple health issues.

However, there are recent indications that suggest that the dangers of prescribing multiple medications—a practice called "polypharmacy"—may be overstated. A Scottish study found that over 10 percent of patients with long-term health problems are taking more than seven different medications; overall, fully half the patients in the study had multiple prescriptions. In many cases, these patients had more than one illness as well. The patients who were most at risk from complex pharmaceutical regimens were those taking multiple medications for a single illness. Health outcomes for patients with many illnesses who were taking medications for each of them did not rise with the number of drugs.

This does not mean that careful management is not important. Patients should make sure to tell all doctors and pharmacists about all the medications they are taking—if possible, getting everything filled at the same place, for ease of record-keeping. Pharmacists should be on the alert for potentially dangerous interactions, especially when more than two or three different types of medication are involved, but it’s a good ideas for patients to remind them when adding a new drug to the list. Supplements and over-the-counter drugs, too, can be sources of interaction problems.

That noted, however, it is clear that prescribing multiple drugs to patients who need to be taking them is not generally a hazard. Indeed, it would be worse for doctors to provide insufficient medicines to patients out of fear of over-medicating them. While there is something to be said for creating the simplest possible regimen—for example, a complex set of instructions over what to take, when, and how might be difficult to follow and promote noncompliance—doctors should not hesitate to prescribe whatever is needed.

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