Some need to be taken three times a day. Deepina Pal, 26, has been living with chronic kidney disease since she was 16 and has been on dialysis for nine years. She takes about 10–12 different kinds of medicines every day for multiple autoimmune and other chronic conditions, including medicines for blood pressure, cholesterol, thyroid and heart conditions, as well as migraine and other problems.
Deepina’s experience reveals an important factor when it comes to taking many medications: the number of medicines does not, by itself, mean that treatment is inappropriate. The safety concern is whether every medicine remains necessary, effective and suitable as a person’s health changes. It is particularly common among older people living with multiple chronic conditions, although complex treatment regimens can occur at any age. Manicka Saravanan, consultant, geriatric medicine, Apollo Hospitals, Greams Road, Chennai. A person living with diabetes, hypertension and heart disease, for example may need several medicines. The concern only arises when medicines no longer have a clear benefit, duplicate one another, interact adversely or create a treatment burden that outweighs their benefit. A patient may inadvertently receive duplicate medicines, particularly when several doctors prescribe for different conditions. Drug combinations can also cause harm. Some medicines used in heart failure or for blood pressure can affect potassium and kidney function; antifungal drugs can interact with anti-epileptic medicines, while some combinations can increase blood-thinner levels and the risk of bleeding. Taking an extra dose can also be dangerous. An additional diabetes medicine may cause hypoglycaemia, while missing certain medicines, such as anti-epileptic drugs, can trigger seizures. Saravanan. Kidney and liver function, nutrition, cognition, mobility, falls risk, cost and difficulties with swallowing or complex timings should also be considered.
Polypharmacy is generally described as the regular use of five or more medicines; the use of 10 or more is often termed hyperpolypharmacy.
“Not every case of polypharmacy is inappropriate,” says S. Smitha Jain, consultant, internal medicine, SIMS Hospital, Chennai, says problems can arise when medicines prescribed by different specialists are considered separately rather than as one treatment plan. A medication review should ask why each medicine was started, whether it is still needed, whether the dose remains appropriate, and whether there are side effects or interactions, says Dr.
