Depending on the estimate, roughly half to more than two-thirds of Americans take at least one prescription, with more than 1 in 5 Americans taking three or more prescribed drugs, according to the Centers for Disease Control and Prevention. One in 10 take five or more prescriptions, and the numbers only climb as individuals get older.
Add to that the over-the-counter medications and supplements many take, and experts say this can be a recipe for an unstable cocktail that threatens therapeutic benefit, sometimes leaving patients worse off than before they started taking the drugs.
“The stakes are pretty high for patients who take multiple medications,” says Dr. Gerardo Moreno, assistant professor of family medicine at the David Geffen School of Medicine at University of California–Los Angeles, and co-director of UCLA’s MyMed’s program, which helps patients properly manage their medications. “There’s a risk of drug-drug interactions; there’s a risk of drug-disease interactions.”
Moreno explains that the dangers resulting from patients’ use of multiple drugs simultaneously, also called polypharmacy, can lead to emergency room visits and hospitalizations, worsen a disease state or cause additional physiological problems. Taking numerous medications that all contain acetaminophen, the ubiquitous active ingredient in Tylenol, for example, can lead to liver damage over time.
The reasons for polypharmacy are many.
Older patients frequently see multiple providers, with limited communication occurring between them, leading to medication overlap or overkill. The fast pace of modern American medicine often leads to a prescribe first, talk lifestyle changes later, if at all, approach, and health providers say aggressive advertising by pharmaceutical firms nudges some patients to walk into doctors’ offices expecting to leave with featured drugs.
Though providers debate the extent of overmedication in kids, issues related to taking multiple medications can extend to pediatric patients as well, including those being treated for mental health concerns.
“The problem is a lot of the psychotropic medications that we use in pediatrics have not been studied in combination with other treatments,” says Dr. Robert Grundmeier, a pediatrician and director of clinical informatics in the department of biomedical and health informatics at the Children’s Hospital of Philadelphia. “So the safety … is not known.”
Grundmeier says roughly 1 in 5 children taking psychotropic medications — everything from ADHD drugs to antidepressants — is on a combination of pharmaceuticals. That’s according to research he led evaluating the health records of nearly 47,000 U.S. patients ages 0 to 18 placed on psychotropic medications from 1999 to 2013.
Grundmeier presented initial findings of his research earlier this month at the annual meeting of the Pediatric Academic Societies, an international conference focused on children’s health research.
He hopes future study will provide pediatricians with the information needed to properly step-down medications, where appropriate.
For kids and adults, medications can have positive or detrimental effects based on how they’re managed by providers, patients and parents, among other factors, both he and Moreno say.
Fortunately, physicians most familiar with polypharmacy issues say solutions come in multiples, too. These steps can help keep you or a loved one safe.
1. Get all questions answered before taking a new medication.
What will this treat? How long will I take it? What are the side effects? How will this interact with drugs I’m currently taking?
Seize the moment to address questions upfront about a newly recommended drug.
“The opportune time is when it’s being prescribed, the first time,” Moreno says. “Because when they’re prescribing that cholesterol medication maybe that’s a time [to ask] ‘Well, is there an alternative treatment I can do?'”
Discuss non-pharmaceutical alternatives, like making healthy lifestyle changes, and whether it’s appropriate to try those first.
2. Write down what you’re taking.
Jot down the name of the medication, and what it’s meant to treat.
And go beyond prescriptions. Include all the over-the-counter meds and vitamins or supplements taken since those, too, may have side effects and interact with prescribed drugs.
Worried your child is on too many prescriptions? “I think it’s important that parents, when they talk with their clinician, state clearly that they’re concerned about the number of medications their child is taking,” Grundmeier says.
Doctors recommend that adult patients do the same if they’re concerned about how many medications they’re taking.
3. Review medications regularly.
Moreno encourages adults, particularly older patients, to meet with their primary care provider annually to discuss the medications they take — how they’re working, any side effects they’re producing — and look for opportunities to safely reduce that number. That includes discontinuing medications no longer needed because a condition abated or because they lack proven long-term benefits.
“A lot of these medications will be marketed to treat a certain condition. It sort of treats the symptoms, but the studies and the data don’t show that long-term it really makes a difference as far as outcomes,” Moreno says, whether it’s reducing heart attacks or strokes, adding years to a patient’s life or improving their quality of life.
Frequently patients continue taking medications long after a health issue has subsided, he notes. Providers, too, may fail to discontinue prescribing a drug to patients after it’s no longer needed.
Dr. Virginia Keane, a pediatrician at Mt. Washington Pediatric Hospital in Baltimore who specializes in treating kids with complex health care needs, from those on ventilators to pediatric patients who have sustained traumatic brain injuries, says she follows up regularly with all her pediatric patients taking multiple medications.
“I see them every three months, at a minimum,” she says.
“Don’t let the doctor say, ‘I’ll see you in six months,'” Keane adds, stressing that kids on multiple medications must be seen more frequently.
She says parents should be proactive in cataloging the drugs their children take and ask the doctor if each medication is still needed. Be aware, too, of the side effects of each medication, Keane says, and report those, should they occur.
5. Shift to fewer meds during the transition of care.
Keane doesn’t think most kids are overmedicated, noting in particular that children taking mental health medications often face complex issues that require multiple therapeutic approaches, which often change over time.
Still, she shares Grundmeier’s concerns about the unknown risks of polypharmacy, noting that drugs are typically tested in isolation, rather than in combination. “As a clinician, [when you’re prescribing multiple medications] you have to be very vigilant about side effects and interactions of the drugs,” she says.
One opportunity to reduce that risk and the total medications patients take, she says, is through better coordination of care from hospitals to outpatient centers, like doctors’ offices. “There are some kids who are overmedicated, particularly kids as they’re coming away from a hospitalization,” she says.
Given how sick a patient typically must be today to warrant hospital admission, it’s not uncommon for many to receive a fistful of prescriptions to treat what ails them. “Once they’re out of the hospital, they often don’t need the medication they’re on when they’re in the hospital. It’s an unnecessary exposure to potential risk,” Keane says.
Once in the outpatient setting, Keane and Moreno say opportunities exist to talk with doctors about reducing medications. Patients and parents should make sure that prescribed drugs aren’t continued unnecessarily, which can happen along with unchecked side effects when patients aren’t closely monitored.
6. Ask about combination pills.
For certain conditions, such as diabetes and high blood pressure, patients taking two medications may be able to take just one pill — containing both medications — instead.
The advantages of combination pills are mostly convenience for patients and simplification of a complex regimen, which could improve adherence, Moreno says. There is also some evidence of improved safety over taking individual medications.
“This is because combination pills are usually formulated in lower a dose or strength,” he says. “One big review of medication use among those with hypertension, found that the use of combination pills were as effective in lowering blood pressure, but were associated with less side effects compared to the use of monotherapies.”
7. Team up.
As many patients struggle to keep up with their doctors’ orders to fill prescribed medications, health experts say an important caveat remains that patients shouldn’t make the decision to cut back on medications unilaterally.
Rather, talk over alternatives with your physician, and, Moreno reiterates, don’t be afraid to kick the tires on anything the doctor prescribes since it could ultimately affect your health — for better or worse.
“I think a caution for patients trying to reduce the number of prescribed medications is that they should talk to their doctor first” before making any changes, he says. Some medications, for example, can’t be safely stopped cold turkey. “But also [patients should] ask their doctor to make sure that they are taking indicated, evidence-based medications that are shown to improve their long-term health outcomes.”
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How to Safely Reduce the Medications You Take originally appeared on usnews.com
