The pitfalls of polypharmacy and how to avoid this dangerous trap

Polypharmacy can occur when taking multiple prescribed drug prescriptions, with the possibility that they all may not be clinically necessary. And what you don’t know about it can hurt you or someone you care about.

Polypharmacy is the result of a complex medical system — one where physicians are more than eager to pull out their prescription pads for patients who, perhaps unbeknownst to them, are likely seeing other physicians who may be treating them with different medications for the same and other medical conditions.

The problem is widespread and dangerous… International research indicates that polypharmacy in most prevalent among those residing in nursing homes, but it’s not restricted to nursing home residents.

In 2017, adults over 65 made up just 13 percent of the population, but they used 30 percent of all prescription meds — most taking five or more medications daily, many of which are not even medically necessary!

Worse, the research shows a strong relationship between the number of medications (extent of the polypharmacy) and negative health consequences. Moreover, each additional prescription medicine adds additional financial burden.

Most seniors and near-seniors simply follow their doctor’s recommendations when it comes to prescriptions. They take all of them and don’t question their doctors, but I recommend that you question your healthcare providers, especially about each medicine.

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How your doctor can reduce or eliminate prescription medications

I don’t advocate that anyone just stop taking a medication they’ve been prescribed. After all, I am a medical doctor. I write prescriptions every day.

But I do my best to diligently know my patient’s history and what other medications they take and what other doctors they may be seeing.

As an integrative physician, I’m also aware of safe alternative means of treating some conditions that don’t require resorting to pharmaceuticals. But any decision to stop medications requires a healthcare provider well-versed in a person’s medical history. And even then some medications may be necessary depending on the individual.

There are certain medications that are more concerning than others, especially when used long-term. Those are the ones to engage with your doctor in a conversion about, such as:

1. The most potentially dangerous for long-term use. For example, Lisinopril for blood pressure control is quite harmless, has only one uncommon side effect I’ve ever seen (cough) and has many studies to show it reduces heart disease and extends life. Whereas Proton-pump inhibitors (PPI’s), such as Nexium, Protonix, and Prilosec, for one month, can raise stomach pH (less acidity) to help allow for healing, but long-term use is fraught with several unwanted adverse effects such as:
   • Disrupts healthy bacteria: taking omeprazole causes you to have higher counts of “bad” bacteria such as Salmonella and Campylobacter infections
   • Increases stomach cancer risk
   • Reduces absorption of magnesium, associated with sometimes seriously low calcium and potassium within one year of taking a PPI. Also, it can impair the absorption of vitamin B12.
   • Increases risk of heart-related and other complications. One author stated, “Being highly lipophilic drugs, they may potentially affect several pathophysiological pathways involved in cardiovascular and kidney morbidity [disease], immune response and infections, absorption of selected nutrients, bone metabolism and cognitive function.”
2. Easily removable with little to no ill-consequences, under a physician’s guidance. Examples are:
   • Blood pressure medicines often do very little to “control” blood pressure; stress, diet, and exercise play a huge role here. I know because most patients who come to the Urgent Care with pain or distress have elevated BP but tell me it is usually normal at home when they are relaxed.
   • Statins can be removed if the patient is over age 75 (not effective) or is willing to do any number of lifestyle cardiovascular risk reduction methods
   • Any medicine that simply is not necessary to maintain health
3. Costly but do very little in the way of disease reversal (do any drugs actually reverse disease?) and symptom control. Ask your doctor what every medication you take does. With his help, you can judge if every medication is either making an improvement, preventing something from getting worse… or doing little to nothing.

It does take a person who is willing to take a close look at all the lifestyle habits that are turning on disease genes. It is a process, but after a year most medications can be eliminated by establishing natural and healthier habits.

Sources:

1.  Clinical Consequences of Polypharmacy in Elderly — Expert Opinion on Drug Safety
2.  Polypharmacy — U.S. Pharmacist
3. Ribiere S, Guillaumot MA, Barré A, Abou Ali E, Barret M, Chaussade S, Coriat R. [What is the REAL long-term risk of proton pump inhibitors?] — Presse Med. 2019 May;48(5):503-510. PubMed PMID: 30926204
4. Hoorn EJ, van der Hoek J, de Man RA, Kuipers EJ, Bolwerk C, Zietse R. A case series of proton pump inhibitor-induced hypomagnesemia — Am J Kidney Dis. 2010 Jul;56(1):112-6. PubMed PMID: 20189276
5. Corsonello A, Lattanzio F. Cardiovascular and non-cardiovascular concerns with proton pump inhibitors: Are they safe? — Trends Cardiovasc Med. 2018 Oct 21. Review. PubMed PMID: 30389278