Polypharmacy: What Do You Need to Know?

Polypharmacy refers to a situation where a patient takes more than four types of medicines concurrently to treat one or more diseases.

Those who are exposed to the harmful effects of polypharmacy are the elderly, due to the likelihood of them having more than one type of disease.

However, polypharmacy also has the potential for harm, particularly if the patients have the following attributes:

• Taking medicines for more than one type of disease or illness
• Consuming a variety of traditional and complementary medicines, supplements, and general medicines (Over-the-Counter products, OTC).
• Visits and follow-ups with more than one doctor or pharmacist to obtain treatment.
• Having vision or hearing problems that may lead to difficulties in reading the labels or listening to detailed instructions relating to the correct way of taking medicines.
• Suffering from conditions such as forgetfulness or senility.
• Staying alone or having no caretaker to assist in the handling of various types of medicines.

The unwanted effects due to polypharmacy include; medication errors, non-compliance with medications, increased risk of experiencing adverse effects of medicines, increased rate of hospital admissions, increased risk of experiencing drug interactions, and also increased medical costs.

Medication errors may occur when patients find themselves easily confused with the given instructions concerning the consumption of medicines.

This usually happens when the number of medicines that needs to be taken is more than four different types. In addition, for the elderly, the risk of medication errors is higher because of the increased probability of poor vision and hearing, along with forgetfulness and senility.

Apart from that, the practice of seeking treatment from multiple healthcare facilities may also result in medication errors, given that patients might receive various types of medicines from each facility.

This scenario not only confused the patient, but gives rise to a major problem when the medicines taken are the same (same active pharmaceutical ingredient), but differ in brands, shapes, sizes, and colours.

Polypharmacy can also contribute to the non-compliance of medicines, especially when patients have to take medicines in large quantities. The more medicines a patient has to take, the more complex the treatment regimen becomes.

This will sometimes cause patients to become less motivated and may increase the risk of taking medicines at the wrong time or skipping the doses entirely. Among the elderly, difficulties in swallowing medicines can become one of the main factors of medicine non-compliance.

Drug interactions may occur when a person takes multiple medicines.

For patients with chronic diseases, the potential for drug interactions has been carefully examined and studied by doctors and pharmacists when prescribing medicines, regardless of the quantity.

However, the consumption of herbal, traditional and general medicines (OTC) together with prescription medicines without the doctors’ knowledge may cause drug interactions as well.

Furthermore, drug interactions may result in an increase or decrease in medicine’s efficacy.

If the interaction decreases the effectiveness of the medicines, the patient might not experience the intended benefit of the treatment.

Whereas, if the interaction increases the medicine’s effectiveness, it may lead to toxicity, causing harm to patients.

Medicine non-compliance and drug interactions attributed to polypharmacy may increase the rate of hospital admissions, leading to an increase in the cost of healthcare in the future.

Tips to prevent polypharmacy and its effects.

Patients are also advised to bring along their medicines whenever seeking doctors or pharmacists to get the best medical advice.

Patients’ involvement in overcoming the negative effects of polypharmacy is vital.

Through their involvement, additional information regarding the suitability of consuming traditional and complementary medicines, supplements, and OTC medicines could be identified and accurate medical advice can be provided by doctors and pharmacists.

Please call the National Pharmacy Call Centre (NPCC) at the toll-free line 1800-88-6722, weekdays from 8 am to 5 pm if there are any inquiries regarding the use of medicines.

Prepared by Ahmad Dhiyauddeen Abdul Shukor, pharmacist from the Health Ministry.