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How Pharmacists Can Work Toward Reducing Polypharmacy

Reference image: Unsplash

Do you know someone who is overwhelmed with managing multiple medications? Maybe you know a close relative or have even seen this happening in practice settings. These experiences may be due to polypharmacy, and it’s a growing concern, especially among older adults. Polypharmacy refers to the use of several medications, typically five or more, daily. It is common in individuals with multiple chronic conditions, such as arthritis, asthma, diabetes, or hypertension. According to the Centers for Disease Control and Prevention (CDC), 7 in 10 adults aged 40-79 in the United States used at least one prescription drug in the past 30 days, and around 1 in 5 took five or more prescription drugs. While polypharmacy can help manage complex health issues, it also raises safety concerns, making pharmacists essential in ensuring safe medication use.

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As you can imagine, taking so many medications daily can pose health risks for the patient. Here’s why polypharmacy can be a significant concern:

  • Complex Medical System

Older adults frequently manage several chronic conditions, which leads to polypharmacy. This often involves various medications prescribed by multiple doctors, sometimes filled at different pharmacies. This makes it difficult to track what they are taking at one time.

  • Tracking and Management

Keeping up with multiple medications can be difficult with all the pills, varying dosages, and times of administration. This often leads to trouble with medication adherence and can result in missed doses or improper medication use, further complicating health management.

  • Increased Risk of Adverse Reactions

The use of excessive or unnecessary medications can increase the risk of experiencing adverse drug reactions and drug interactions. This risk is particularly significant in the aging population, as changes in body composition and metabolism can affect how medications are absorbed, distributed, and eliminated. As a result, older adults are more susceptible to side effects and unintended consequences from their medications.

  • Increased Health Costs

Polypharmacy can lead to adverse effects that may require hospitalization. If not managed properly, this can trigger a prescribing cascade, where a side effect of one medication is misdiagnosed as a new condition and treated with additional medications. This cycle can have serious health consequences, increasing both the patient’s care costs and the likelihood of repeated hospitalizations. The added burden of managing these issues also increases expenses for the healthcare system.

Often, these issues are preventable. Healthcare professionals, particularly pharmacists, play a crucial role in managing medications and preventing such complications. The World Health Organization (WHO) outlines the following key steps for ensuring medication safety:

Reference image: World Health Organization (WHO)

As the figure describes, medications should be reviewed for appropriate prescribing. A helpful resource that assists with evaluating medication risks in elderly patients is the American Geriatrics Society Beers Criteria®. The AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults is updated every three years and provides a list of medications to be used cautiously or avoided in older adults. This includes drugs generally inappropriate, those to avoid in specific conditions, those to use cautiously, drug-drug interactions, and dose adjustments based on kidney function.

Other ways pharmacists can be involved in a patient’s medication management include encouraging patients to maintain an up-to-date list of all their medications, including prescriptions, over-the-counter drugs, and supplements. This list should be shared with healthcare providers to identify potential side effects and interactions. Patients and caregivers should be counseled on common side effects to watch for. These commonly include:

  • Headaches and confusion
  • Dizziness and falls
  • Weight changes
  • Memory or cognitive issues

Encouraging regular checkups and having all prescriptions filled at one pharmacy can help pharmacists monitor for potential drug interactions and manage medications more effectively. If necessary, they can coordinate with physicians to review medications and explore safer alternatives for the patient. Furthermore, the patient may consult a pharmacist before purchasing any over-the-counter product or supplement to ensure safety with current medications or health conditions. Medication reconciliation during transition of care settings further supports safe medication use by addressing any inconsistencies and errors in medication lists as the patient moves between different care settings.

All in all, while taking multiple medications has its risks, it can also happen out of necessity, such as in patients with diabetes who may require multiple medications. As a result, it is crucial to manage and monitor it carefully. Regular check-ups and clear communication about medications can help mitigate the risks associated with taking multiple drugs. Deprescribing also needs to be approached carefully, as stopping certain medications can lead to withdrawal effects or exacerbate existing conditions. The objective is to minimize inappropriate polypharmacy where too many medications are prescribed inappropriately, while ensuring that the use of multiple medications is truly beneficial for the patient’s health. By focusing on effective management and informed patient care, we can make reduce polypharmacy and improve health outcomes.


Winnie Chu

RxPharmacist Team

Resources

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Are Supplements Worth the Hype? What You Need to Know 

Are those supplements on your shelf truly boosting your health, or just empty promises? According to the Centers for Disease Control and Prevention (CDC), 57.6% of U.S. adults over the age of 20 used a dietary supplement in the past 30 days between 2017 to 2018. This is an approximate 10% increase among all adults from 2007 to 2008. With the rising trend of supplement use, it is worthwhile to explore whether you are taking these supplements safely and really reaping the health benefits marketed to you.   

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Supplements vs. Prescription Drugs

There are many types of supplements, including vitamins, minerals, herbal medications, enzymes, and amino acids. The purpose is to support the body by providing the additional nutrients needed to meet daily intake requirements. Supplements can come in a variety of forms including tablets, capsules, gummies, powders, and more.

Unlike prescription drugs, dietary supplements are not closely regulated by the U.S. Food and Drug Administration (FDA). That is, the FDA is not heavily involved in the pre-market approval process but rather more focused on post-market surveillance. Instead, the manufacturer and distributors are responsible for ensuring the supplement’s safety before entering the market. They are required to submit data regarding the supplement’s safety, but not effectiveness. As a result, supplements cannot claim to treat, prevent, or cure diseases. Yet, manufacturers are allowed to skate by, stating the supplement “supports” or “enhances” a body organ or function. Furthermore, the labeling may not always reflect the actual contents. In fact, a 2013 study found that compounded vitamin D3 supplements varied greatly in potency, with only one-third of the study pills meeting US Pharmacopeial (USP) Convention standards and containing the appropriate amount of active ingredient.

The Risks of Overuse and Interactions

Supplements are widely available over the counter and online, leading some individuals to use them even when they might not need additional nutrients. While generally safe in moderation, it’s important to remember that too much of a good thing can be problematic. This is especially true for individuals with multiple chronic conditions or those taking various medications. Some dietary supplements may interact with other medications, potentially reducing the effectiveness of prescribed drugs or leading to adverse effects.

Below is a table with some common supplements with common side effects, drug-drug, and drug-food interactions to look out for. This is not a comprehensive list but demonstrates how taking many supplements can pose more risks than benefits if not taken appropriately.

Managing Supplements Safely

With loose pre-marketing regulations and a potential risk for drug interactions and side effects, how can supplements be taken safely? It is highly encouraged that patients take caution and consult with their healthcare provider or pharmacist before starting any new supplements. Healthcare professionals, especially pharmacists, can help assess potential risks and interactions with current medications. It is also helpful to bring a list of all medications, including dosages and frequency, to all healthcare consultations. Patient education is especially crucial when it comes to understanding and making decisions about supplement use. Here are some available resources and tools to learn more about supplements:

Takeaway

With many supplements claiming various health benefits nowadays, it helps to consult with healthcare providers and pharmacists to ensure safety and effectiveness. Their expertise can help navigate potential risks and interactions, making informed decisions easier. By seeking professional guidance from healthcare providers and staying informed, you can make better choices that truly support your health.


Winnie Chu

RxPharmacist Team

Resources
  1. Centers for Disease Control and Prevention. (2023). Use of Prescription Medications Among U.S. Adults Aged 20 and Over. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db399.htm
  2. American Pharmacists Association. Dietary Supplements: What You Need to Know. Available at: https://aphanet.pharmacist.com/sites/default/files/files/APhA-DietarySupplements-Brochure-14×8%205-A7.pdf. Accessed July 25, 2024.
  3. LeBlanc ES, Perrin N, Johnson JD, Ballatore A, Hillier T. Over the Counter and Compounded Vitamin D: Is Potency What We Expect? JAMA Intern Med. 2013;173(7):585-586. doi:10.1001/jamainternmed.2013.3818. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1570096.
  4. U.S. Food and Drug Administration. Questions and Answers on Dietary Supplements. Available at: https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements. Accessed July 25, 2024.
  5. National Center for Complementary and Integrative Health. Yohimbe. Available at: https://www.nccih.nih.gov/health/yohimbe#:~:text=Yohimbe%20is%20an%20evergreen%20tree,and%20to%20enhance%20sexual%20performance. Accessed July 25, 2024.
  6. National Center for Complementary and Integrative Health. Kava. Available at: https://www.nccih.nih.gov/health/kava. Accessed July 25, 2024.
  7. National Center for Complementary and Integrative Health. Red Yeast Rice. Available at: https://www.nccih.nih.gov/health/red-yeast-rice. Accessed July 25, 2024.

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