What is polypharmacy? Polypharmacy refers to the use of a large number of medications, commonly considered to be the use of five or more. Polypharmacy is a consequence of having several underlying medical conditions. As we age, an estimated 30 percent to 40 percent of patients take five or more medications. An analysis of older adult beneficiaries of a large governmental health plan documented the use of multiple medications. Among users of the pharmacy benefit, the average number of medications was six per user. Forty-seven percent used five or more medications, 13 percent used 10 or more, and 3 percent used 15 or more. The term implies an assumption that using one or more of these medications may be questioned or unnecessary. Polypharmacy also can be defined as the use of more medications than are clinically indicated.
Why the need for polypharmacy? As stated above, a major reason for polypharmacy is that a patient has many co-existing medical conditions receiving treatment. In addition, in the case of diseases such as heart failure and high blood pressure, combinations of two to three different medications are common and recommended. If medications for symptomatic relief are added, it is easy to see why patients end up with a large number of medications. Sometimes a new medication is prescribed to treat the adverse effects of another drug, often discontinuing or changing the dose of the offending drug would solve the problem. A contributing factor is that patients see different physicians for their medical problems, and being under the care of several specialists is a major reason for polypharmacy. This can be true because specialists often focus on their area of expertise rather than on the patient as a whole. There is often a need for a primary care physician — a general internist, a family practitioner or a pediatrician — to coordinate the use of multiple medications. Another reason for polypharmacy is that the documentation of why a medication was prescribed initially is often missing in the medical record, making decisions to consider termination of a treatment difficult to make later. As a result, there is a tendency for doctors to let patients continue the medications they are taking, especially if the indications are unclear or unknown. In addition to medications lacking an indication, other medications may be of limited value or are therapeutic duplications.
What are the consequences? The major consequence of polypharmacy to a patient is a much higher risk of adverse drug effects. This risk increases based on the number of medications prescribed and taken. These adverse drug effects often require physician contacts and, in some cases, emergency room visits or hospitalizations. Moreover, if an adverse effect emerges, it can be very difficult to figure out which of the many drugs is the cause. Another possible problem is what is referred to as medication or drug interactions, meaning that the effects of one medication, may change if given together with another medication. Thus, taking five or more medications leaves many opportunities for such interactions. The knowledge of medication interactions gained during the drug development phase is often limited due to incomplete testing. Polypharmacy also places a burden on patients to remember when and how to take all prescribed medications. Multiple medications increase the risks of inappropriate medication use, non-adherence, adverse effects and medical cost.
What can be done about polypharmacy? A medication review for patients prescribed a large number of medications. Regular reviews are recommended to determine the appropriateness of use of all medications.
Information gathered by: Express Script
Questions about medicine? ask the Pharmacist. We are honored to host a panel of four very well respected local community experts in their field of pharmacy. Meet our panel:
Sean Wimberly, PharmD, BCPS
Tallahassee Memorial Hospital, FSU College of Medicine Faculty
Sean has been a clinical pharmacist for eight years. He received his PharmD from the University of Florida in 2011. He completed a residency at TMH and is now a preceptor for the TMH residency. Sean is also a part-time faculty member with the FSU College of Medicine where he teaches pharmacology. Aside from his professional life, he coaches the Visual Teams for the Marching Chiefs and directs the FSU Winer Guard. Sean is an undergraduate of FSU where he will always be remembered as one of the renowned FSU feature twirlers at the Seminoles football games.
Angie Williams, RPh
Monticello Winn-Dixie, 20+ years
With over 20 years as a Winn-Dixie pharmacist, Angie is a graduate of Samford University – McWhorter School of Pharmacy. When she’s not helping the Monticello community with all their pharmacy needs, you’ll find her spending time with her family, especially her two sons – both active athletes. She is a believer in PURE – quality products that support nutrition, performance, beauty and life balance. With any extra time she can slip in, Angie makes the drive into Tallahassee to workout at Just Get Fit!
Charles McArthur, RPh
Retired Registered Pharmacist for over 50 years
Charles McArthur has been a registered pharmacist for over 50 years. After graduating from Samford University, Charles began practicing retail pharmacy in the building currently housed by Uptown Café. After a short detour into chain-store pharmacy, he began his 13 years at Sullivan Drugs, presently the Walgreens across from TMH. Since this store was open 365 days a day, and until midnight every day, Charles crossed paths with multitudes of patients and their families, and became friends with many of the physicians of the time. Next, the opportunity arose for Charles to open a psychiatric hospital pharmacy for Apalachee Human Services. Psychiatric pharmacy was truly a new world, coming from a background in retail pharmacy. From there, Charles was approached about becoming Pharmacy Chief for the State of FL Dept. of Health’s Central Pharmacy. As an administrator, Charles had many assorted duties, including traveling to hurricane sites within the state in order to supply urgently needed medications, supplying vaccines for the smallpox and anthrax scare following 9/11, among other essential public health tasks. This was a fascinating but intense period. Charles was a beloved and well-respected Pharmacy Chief. He was then promoted to Director of Statewide Pharmaceutical Services for the State of FL. Charles retired from full-time practice 12 years ago, and since then has filled in at community pharmacies in Tallahassee and surrounding communities. He continues to be registered as a pharmacist in FL and Georgia.
Faith Maignan, PharmD
Tallahassee Memorial Hospital
Faith Maignan is an energetic, colorful, free-spirited Tallahassee native, wife of JGF’s Coach Chris Maignan. After high school she went on to complete her undergraduate coursework and also obtain her Doctorate of Pharmacy from the University of Florida in Gainesville, Florida. It was here in her second year of pharmacy school that she met Coach Chris and fell in love with his skillful cooking. During her time as a pharmacy student Faith also discovered a strong interest in Infectious Disease, specifically HIV and the public health issues surrounding patient care. This interest was pursued by completion of a summer research fellowship at The Johns Hopkins Hospital, AIDS Healthcare Foundation Pharmacy internship, and CDC pharmacy rotation in Atlanta, GA.
After receiving her PharmD, she briefly worked at Orlando VA Medical Center, but not soon after decided to relocate back home to Tallahassee to be closer to family. Her pharmacy career in Tallahassee began at Capital Regional Medical Center, where she worked as a clinical pharmacist both in the main pharmacy and on hospital floors, assisting physicians and nurses with drug information questions. After two years at CRMC, Faith decided to pursue a position at Tallahassee Memorial Hospital, where she currently works as a clinical pharmacist primarily at TMH’s Outpatient Cancer Center.
Throughout her life, Faith has always strived to balance the studying and intensity of her pharmacy career with dancing, exercising, and overall pushing to maintain emotional and spiritual health. With her husband by her side, she loves to laugh, meet new people, travel, eat great food, and search for new challenges. This past year, with the support of her husband, she decided to fully immerse herself into consistently exercising and pursuing her desire of becoming a Strong by Zumba (SBZ) instructor. She attends Coach Chris’ class Tuesdays and Thursdays and hopes to begin teaching SBZ at JGF very soon!
Join us at Just Get Fit, Thursday, October 17 at 6:30PM. This event is part of JGF’s complimentary educational series – open to everyone community wide! Invite your family and friends…