What is polypharmacy (the use of multiple medications) and its implications on prescribing practices?

From the Guidelines

Polypharmacy should be managed through a systematic approach that includes patient education, comprehensive medication reviews, and deprescribing when necessary, as evidenced by the most recent study in 2025 1. To explain polypharmacy and prescribing practices, healthcare providers should focus on patient education and careful medication management.

Key Points to Consider

• Polypharmacy is associated with increased adverse drug reactions, drug-drug interactions, medication non-adherence, and higher healthcare costs, particularly in elderly patients due to age-related changes in pharmacokinetics and pharmacodynamics 1.
• A comprehensive medication review should be conducted to identify unnecessary medications, potential interactions, or duplications, and to evaluate each medication's indication, effectiveness, dosage, and potential side effects 1.
• Deprescribing, the systematic process of identifying and discontinuing medications when existing or potential harms outweigh benefits, should be implemented when appropriate, using established criteria such as the STOPP/START or Beers criteria 1.
• Medications such as anticholinergics, benzodiazepines, antipsychotics, and opioids should be discontinued owing to their potential adverse effects, and potential interactions between medications and medical conditions should be evaluated 1.
• Effective communication between healthcare providers and patients about medication regimens is essential for safe prescribing practices in the context of polypharmacy 1.

Management Strategies

• Regularly conduct comprehensive medication reviews to identify areas for improvement 1.
• Use established criteria such as the STOPP/START or Beers criteria to assess potentially inappropriate medications 1.
• Consider the patient's functionality, support needs, and living situation when making decisions about medication management 1.
• Educate patients and caregivers about the importance of medication management and the potential risks associated with polypharmacy 1.

From the Research

Definition and Prevalence of Polypharmacy

• Polypharmacy is defined as the regular use of at least five medications, and it is a common issue in older adults and younger at-risk populations 2.
• The prevalence of polypharmacy among the elderly population is high, with one study reporting a prevalence of 97.2% 3.
• Polypharmacy is associated with higher morbi-mortality and a socio-economic burden 4.

Risks and Consequences of Polypharmacy

• Polypharmacy increases the risk of adverse medical outcomes, including undesirable medication reactions and drug interactions 2, 3.
• The risk of potentially serious drug-drug interactions (DDIs) increases exponentially with the number of medications consumed 3.
• Polypharmacy can lead to financial hardship, pill burden, and a decrease in treatment adherence 2, 5.

Strategies for Managing Polypharmacy

• Medication review is a solution to limit Potentially Inappropriate Medication (PIM) and polypharmacy, especially in the elderly and in cases of poly-morbidity 4.
• Tools such as the Beers criteria, the PRISCUS list, the STOPP/START criteria, the MAI (Medication Appropriateness Index), and the Good-Palliative-Geriatric Practice Algorithm can support medication review 4, 2.
• Deprescribing unnecessary medications is recommended to reduce pill burden, the risks of adverse drug events, and financial hardship 2.
• Patient involvement in the medication management process is crucial, and patients' experiences and treatment goals should be elicited 6.

Clinical Practice Guidelines for Polypharmacy Management

• A scoping review of clinical practice guidelines found that the most common recommended strategy for managing polypharmacy is a medication review conducted by a general practitioner and/or a community pharmacist 6.
• Guidelines recommend involving the patient in the process, mostly to elicit the patient's experiences and treatment goals 6.
• However, guidance on task division and implementation of guidelines in practice is less clear, and there is room for guideline improvements 6.