Taking Steps to Reduce Polypharmacy
Polypharmacy has been given different definitions. But essentially it boils down to giving a patient more drugs than they need to treat a problem or problems. Giving more drugs than necessary is a problem in and of itself from side effects and drug interactions.
Polypharmacy has become a growing problem because the emphasis in healthcare today runs in one direction — in diagnosing and prescribing drugs, while giving little attention to reducing dosages or eliminating the usage of drugs.
There are not very many clinical guidelines covering the reduction of a medication regimen, and so practitioners are reluctant to curtail medication that has been prescribed by someone else. Polypharmacy generally impacts older patients more because they are usually on multiple medications.
Here are a few ideas from pharmacists to prevent polypharmacy.
Medications should be prescribed only for FDA-approved usage.
For example, oral naltrexone has been approved only for alcohol and opioid dependence, but some have prescribed it for impulse control disorders.
Look at possible drug interactions.
Pharmacists need to be aware of what drugs interact with each other and how, and should attempt to limit the number of medications to prevent deleterious drug interactions.
One example of this is CYP3A4 substrates, which reduce the effects of about half the drugs being sold today.
Do side effects outweigh benefits?
One study found that men who take a variety of medications often suffer from erectile dysfunction. This could be an example of a side effect being worse than the benefits of the drugs.
Try to avoid using one medication to treat the side effect of another.
This happens more often in older adults, where one medication is prescribed to alleviate the symptoms produced by another medication. Pharmacists should check to see if the problem can be resolved by simply eliminating or reducing the medication that is causing the unwanted symptoms to begin with.
Treating conditions without medication.
Some conditions can be treated without prescribing medication. Heartburn is one example. There are evidence-based ways to treat the condition without drugs, such as elevating the head while sleeping, losing weight and avoiding food later at night.
Check to see if the patient is taking supplements.
Pharmacists should ask patients directly if they are taking any nutritional supplements such as vitamins, as these could have harmful interactions with certain drugs. Patients do not generally reveal they are taking supplements unless asked about it explicitly.
Vitamins A and E, for example, increase anticoagulation effects of drugs like warfarin. And magnesium can inhibit the absorption of antibiotics.
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