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Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many

Author

Listed:
  • Cathal A. Cadogan

    (Queen’s University Belfast
    Royal College of Surgeons in Ireland)

  • Cristín Ryan

    (Queen’s University Belfast
    Royal College of Surgeons in Ireland)

  • Carmel M. Hughes

    (Queen’s University Belfast)

Abstract

The use of multiple medicines (polypharmacy) is increasingly common in middle-aged and older populations. Ensuring the correct balance between the prescribing of ‘many’ drugs and ‘too many’ drugs is a significant challenge. Clinicians are tasked with ensuring that patients receive the most appropriate combinations of medications based on the best available evidence, and that medication use is optimised according to patients’ clinical needs (appropriate polypharmacy). Historically, polypharmacy has been viewed negatively because of the associated medication safety risks, such as drug interactions and adverse drug events. More recently, polypharmacy has been identified as a risk factor for under-prescribing, such that patients do not receive necessary medications and this can also pose risks to patients’ safety and well-being. The negative connotations that have long been associated with the term polypharmacy could potentially be acting as a driving factor for under-prescribing, whereby clinicians are reluctant to prescribe necessary medicines for patients who are already receiving ‘many’ medicines. It is now recognised that the prescribing of ‘many’ medicines can be entirely appropriate in patients with several chronic conditions and that the risks of adverse drug events that have been associated with polypharmacy may be greatly reduced when patients’ clinical context is taken into consideration. In this article, we outline the current perspectives on polypharmacy and make the case for adopting the term ‘appropriate polypharmacy’ in differentiating between the prescribing of ‘many’ drugs and ‘too many’ drugs. We also outline the inherent challenges in doing so and provide recommendations for future clinical practice and research.

Suggested Citation

  • Cathal A. Cadogan & Cristín Ryan & Carmel M. Hughes, 2016. "Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many," Drug Safety, Springer, vol. 39(2), pages 109-116, February.
  • Handle: RePEc:spr:drugsa:v:39:y:2016:i:2:d:10.1007_s40264-015-0378-5
    DOI: 10.1007/s40264-015-0378-5
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    Citations

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    Cited by:

    1. Dirk Heider & Herbert Matschinger & Andreas D Meid & Renate Quinzler & Jürgen-Bernhard Adler & Christian Günster & Walter E Haefeli & Hans-Helmut König, 2018. "The impact of potentially inappropriate medication on the development of health care costs and its moderation by the number of prescribed substances. Results of a retrospective matched cohort study," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-12, July.
    2. Catarina Caçador & Edite Teixeira-Lemos & Jorge Oliveira & João Pinheiro & Luís Teixeira-Lemos & Fernando Ramos, 2022. "The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional Study," IJERPH, MDPI, vol. 19(5), pages 1-13, February.
    3. Derek Stewart & Kathrine Gibson-Smith & Katie MacLure & Alpana Mair & Albert Alonso & Carles Codina & Antonio Cittadini & Fernando Fernandez-Llimos & Glenda Fleming & Dimitra Gennimata & Ulrika Gilles, 2017. "A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people," PLOS ONE, Public Library of Science, vol. 12(11), pages 1-17, November.
    4. Eun-Hae Lee & Ju-Ok Park & Joon-Pil Cho & Choung-Ah Lee, 2021. "Prioritising Risk Factors for Prescription Drug Overdose among Older Adults in South Korea: A Multi-Method Study," IJERPH, MDPI, vol. 18(11), pages 1-11, June.
    5. Marina Lleal & Marisa Baré & Sara Ortonobes & Daniel Sevilla-Sánchez & Rosa Jordana & Susana Herranz & Maria Queralt Gorgas & Mariona Espaulella-Ferrer & Marta Arellano & Marta de Antonio & Gloria Jul, 2022. "Comprehensive Multimorbidity Patterns in Older Patients Are Associated with Quality Indicators of Medication—MoPIM Cohort Study," IJERPH, MDPI, vol. 19(23), pages 1-16, November.

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