Polypharmacy: What Pharmacists Need to Watch For
Polypharmacy — the concurrent use of multiple medications — is common in older adults and increases the risk of interactions, falls, and non-adherence. The pharmacist is often the only professional with the full medication list.
The risks of multiple medications
Each additional drug increases the chance of an interaction, an adverse effect, or a fall — especially in older adults whose metabolism and clearance change with age. Five or more concurrent medications is a recognised threshold for increased risk. The pharmacist's job is to reconcile, simplify, and flag.
Common polypharmacy problems: duplicate therapy (two drugs for the same condition from different prescribers), prescribing chains (a drug added to treat the side effect of another), and drugs that are no longer needed but continue indefinitely.
Deprescribing and reconciliation
Medication reconciliation — reviewing every drug, dose, and frequency at each encounter — is the single highest-impact intervention in polypharmacy. The pharmacist can identify drugs that interact, overlap, or are no longer indicated, and flag them to the prescriber. Deprescribing (the planned, supervised reduction of unnecessary medications) is a collaborative process — the pharmacist identifies candidates; the prescriber decides.
Always encourage patients to bring all their medications — including OTC, herbal, and 'as needed' — to every appointment. The bag on the counter is the data you need.
Practical example
The bag of ten medications
An elderly patient brings in a bag of ten medications from three prescribers. The pharmacist reconciles and finds: two NSAIDs from different doctors, a PPI that was started years ago and never reviewed, and a drug interacting with another. They contact the main prescriber with a summary. Two drugs are stopped, one dose is reduced, and an interaction is resolved — all from one bag review.
Key takeaways
- Five or more medications increases interaction, fall, and adverse effect risk.
- Reconcile at every encounter — the full list, including OTC and herbal.
- Deprescribing is collaborative: pharmacist identifies, prescriber decides.
- Ask patients to bring all medications to every appointment.
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