Polypharmacy: a Macro and personal issue

Since most METARs are, shall we say, mature the issue of polypharmacy probably applies to many of us. It’s also a Macroeconomic issue since the resulting possibility of drug-caused falls and dementia lead to higher medical care costs.

Taking Multiple Medications? You May Need to Scale Back.

Many people in the United States are taking five or more prescription drugs. That can lead to serious complications.
By Knvul Sheikh, The New York Times, April 22, 2024

Around one in five adults between the ages of 40 to 79 is taking five or more prescription drugs, according to data from the Centers for Disease Control and Prevention. And the older patients are, the more likely it is they’re taking even more medications.

But taking many medicines simultaneously, known among medical experts as polypharmacy, increases people’s risk of experiencing severe side effects and drug interactions…

Studies show that taking multiple medications is associated with a faster decline in memory in some patients with mild cognitive impairment, and with a greater risk of falls among people with balance problems or weakened muscles. And certain combinations of drugs can lead to excessive bleeding, dangerously low blood sugar or other serious complications that lead to hundreds of older adults being hospitalized every day…

Patients sometimes also see a variety of medical providers, each of whom may prescribe medication without necessarily communicating with one another.

Sometimes medical professionals may prescribe drugs to treat the side effects of another medication, in what doctors refer to as a “prescription cascade.”…

Experts suggest asking a primary care doctor or pharmacist to do a full medication review at least once a year. Many pharmacies offer such evaluations under free medication therapy management programs. Make a list of your medicines — including supplements and over-the-counter drugs — or grab all of your pill bottles and take them with you to the appointment… [end quote]

I think a pharmacist would probably be better at knowing about drug interactions than a physician. Also, it’s worth Googling the interactions since they can be mind-boggling. One of the meds I take interacts with over 300 different medications. Some of them interact with alcohol.

It’s important to include OTC meds as well as prescription meds. We tend to assume that OTC meds are benign. But even acetaminophen, which causes less stomach irritation than aspirin, interacts with 124 other medications and can cause fatal liver damage if taken in too high a dose.

prescriberpoint.com is a website for healthcare professionals. Check your medication interactions.

When a doctor prescribes a new drug ask if it could interact with other drugs you are taking. Also ask if the symptom could be a side effect of a drug you are already taking and whether the underlying problem could be treated by a different drug with fewer side effects.



Well, in practical terms (unless my experience is dramatically different from the norm…I’m still a relative n00b when it comes to being a patient) before every doctor’s visit a medical assistant clerks me in with the usual measurements of height, weight, temperature, BP etc and runs through my current meds (including OTC) This happens routinely, even on follow up visits from a previous one a couple of weeks before. I’m reasonably sure it’s the algorithm dictated by the electronic medical revords system rather than thoroughness…something like the checkout at the supermarket requiring ID from everyone when alcohol is being purchased before the transaction can succeed. Those medical records systems presumably have a drug interaction platform embedded there…just like the situation with a pharmacy.

The problems with this set up here in the US is that EMR systems don’t always communicate. My hospital visits for specialty care all use Epic but my primary care physician’s office does not. Communicating my status accurately is down to me. I am very reliable in this regard. Not everyone is.

I don’t know how much different pharmacy chains’ systems talk to each other to compensate for folk who pharmacy hop


Yes, and no. It depends if the doctor actually uses AND understands what the system shows. I asked about, and was prescribed, a new drug (Invocana) to see how it worked. Nobody checked interactions with other drugs as far as I could tell. After a short time of use, I looked through the web site for Invocana in order to see what drug interactions were listed. Got a huge surprise. One drug I had been taking for decades reduced the effectiveness of Invocana by about 50%. So a 300mg dose was effectively a 150mg dose (given the reported drug interaction by the mfr). Told my doctor and no more Invocana (at lowest dosage). Now I check every new drug that looks interesting–to protect myself. They use MyChart (big medical system, largest in MN) and I don’t know what it does with regard to drug interaction(s).

In my Corporate America days, I had a running joke with my entire team of engineers and architects that we would bring up every time we encountered some business problem caused by a failure to collect, standardize, secure and expose information in a useful way. It was kind of stolen from Phil Hartman’s old Cave Man Lawyer skit on SNL…

If only there was some sort of BASE…

…in which we could put information, or DATA…

… that supported a consistent LANGUAGE that could efficiently describe a way to extract, or select, or QUERY that information and retrieve it with a consistent format or STRUCTURE. And, really going out on a limb, if there was a set of rules or PROTOCOL to CONTROL the sending / receiving or TRANSPORT of that data between different systems so everyone could use the same data for consistency. You could probably figure out a way to get all of those machines to talk to each other with another PROTOCOL to turn them all into one big INTERCONNECTED NETWORK. You could call it an INTERNET…

(The joke being of course that we HAVE those technologies… databases, SQL and TCP/IP – the foundation of nearly everything you use today.)

It’s frustrating to see hundreds of billions of dollars chasing AI technologies and the creation of guidance software for million dollar missiles yet see low hanging fruit like better healthcare software go unaddressed and see existing systems induce BILLIONS of dollars in waste and harm on the public.