When you’re prescribed a single medication, it can be easy to stay on track. You can stick to the dosing schedule, follow the instructions and watch for any signs of side effects. But as soon as you start taking multiple medications, things get a lot trickier.
“Drugs can have interactions or changes in effectiveness when taken together,” says Ghada Ashkar, PharmD, associate chief of ambulatory pharmacy for UCLA Health. “The more medications you’re taking, the more careful you need to be about managing them.”
What is polypharmacy?
Polypharmacy is defined as taking five or more prescription medications. That may sound like a lot. But according to a report by the Centers for Disease Control and Prevention (CDC), at least one-third of adults in their 60s and 70s take five or more prescription drugs every day.
The problems associated with polypharmacy also become more common with age. Older adults are more likely to be managing multiple chronic conditions — such as high blood pressure, high cholesterol, arthritis and diabetes. In addition, our bodies may react differently to medications as we age. “Your kidneys may not function as efficiently as they used to,” says Dr. Ashkar. “And age can make you metabolize medication more slowly, so it stays in your system longer.”
Risks of taking multiple medications
Any medication has potential risks and side effects. But those risks increase as the number of medications you’re taking increases. And many common side effects from medications can increase when you combine different drugs — prescription or over the counter (OTC).
Drug interactions and side effects to be on the lookout for include:
- Blood thinning: If you are taking a prescription blood thinner, be aware that other medications can affect blood thinning — which can increase risk of stroke or bleeding. Over-the-counter NSAIDs (such as ibuprofen) and some supplements (such as ginkgo biloba) have this effect.
- Dizziness or confusion: Symptoms that affect your balance or mental sharpness can be dangerous because those side effects increase the risk of falls in older adults.
- Rash: A rash or hives can be the first sign of an allergic reaction to a medication. If you experience this, pay attention and make sure the reaction doesn’t get worse and cause swelling in your mouth or difficulty swallowing or breathing.
- Sedation: Many prescription pain medications (including opioids) and antianxiety drugs (such as benzodiazepines) can make you sleepy. That can be problematic on its own. But if you inadvertently mix those with another drug that also causes sedation (such as some OTC antihistamines) the effects can be quite dangerous. In some cases, the sedating effect can even be strong enough to affect your lungs and cause difficulty breathing.
“If you start taking a new medication — especially if you already take several others — tell your doctor right away about any new symptoms or side effects you experience,” says Dr. Ashkar.
Practical tips for safely managing medications
Whether you’re taking one drug or several, it’s important to talk to your doctor regularly about all your medications. The more medications you routinely take, the more important it is to make sure your provider has a complete list. Be sure that list includes prescription medications, OTC drugs, and even vitamins and herbal supplements.
“If you see multiple doctors, be sure to discuss all your medications with each of them,” says Dr. Ashkar. Do a full medicine review with your doctors at least once a year. “You might find that you’re taking something you no longer need or that should be replaced with a different drug.”
She also urges people to discuss new — and long-term — prescriptions with their pharmacist. “Ideally, you should fill all of your prescriptions at the same pharmacy,” she says. “Their systems are set up to flag any drugs that might interact with others you’re taking.”
And if you’re at the pharmacy picking up OTC medications to treat something such as allergies, a cold or stomach upset, it’s worth a quick consult with the pharmacist. “They can look up what medications you’re already taking and make sure the OTC product you’re adding is safe.”
To help you keep track of all your medications and take them exactly as directed, Dr. Ashkar suggests that you:
- Use day-of-the-week pill sorters: At the beginning of the week, sort all your medications into a weekly pill organizer. If you have some pills you take in the morning and others at night, you could even have two containers, clearly labeled AM and PM.
- Set alarms or reminders: For medications that need to be taken at specific times of day, it’s helpful to set an alarm or a reminder on your phone.
- Keep notes nearby: If there are special instructions for any of your medications (such as take with or without food), leave those on a note that stays with your pill box. That way you can easily refer to your instructions without having to search for them.
Taking multiple medications can increase your risk of side effects and other problems. But a little careful management can help keep you safe and healthy.
