The pitfalls of polypharmacy and how to avoid this dangerous trap

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

Polypharmacy results from a complex medical system—one where physicians are eager to pull out their prescription pads for patients who, perhaps unbeknownst to them, are likely seeing other physicians who may treat them with different medications for the same and other conditions.

The problem is widespread and dangerous… International research indicates that polypharmacy is 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. Still, 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 on prescriptions. They take them all and don’t question their doctors, but I recommend 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 know my patient’s history, what other medications they take, and which other doctors they may be seeing.

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

Some medications are more concerning than others, especially for long-term use. Those are the ones to engage with your doctor in a conversation 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 showing 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 magnesium absorption, which can sometimes lead to seriously low calcium and potassium within one year of taking a PPI. It can also impair 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 little to “control” blood pressure; stress, diet, and exercise play a huge role. 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 whether each medication is improving things, preventing something from getting worse, or doing little to nothing.

It takes someone willing to take a close look at the lifestyle habits that turn on disease genes. It is a process, but after a year, most medications can be eliminated by establishing healthier, natural 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