Often defined when a patient is on 5 or more medications
How does polypharmacy occur?
Multiple co-morbid conditions and constant review new evidence to support new and existing treatments
Medications constantly added to without review
No consideration of interactions/side effect
Often compliance/concordance issues
Appropriate vs inappropriate polypharmacy
Polypharmacy can be appropriate in certain conditions when indicated where benefit outweighs risk and benefit is successfully achieved
Inappropriate polypharmacy is when one or more drugs is no longer needed because:
Not achieving desired clinical effect
Resulting in unacceptable adverse drug reaction
Patient unable/difficulty/does not wish to take medications
No evidence base for medication use
Conducting a polypharmacy review
Should be done face to face with patient
Helps if there is an established relationship
Input/advice from pharmacist highly useful
7 steps of polypharmacy review
Identify aims and objectives of treatment
Identify essential drug treatment
Identify potentially unnecessary drugs
Are the drugs effective
Are there ADRs and if so are they acceptable/unacceptable?
Is the treatment cost effective
Is the patient willing to take treatment
Culprit drugs for falls/poor mobility
Cardiovascular