Oct 11, 2021 Do Your Meds Need Management?

Dr. Sara Ali addresses polypharmacy and the potential perils of too many pills.

Sara Ali, MD
Sara Ali, MD

‘Polypharmacy’ is a complex-sounding word with a simple meaning: It refers to the simultaneous use of multiple medications, says Sara Ali, MD, a geriatrics and palliative care specialist at Robert Wood Johnson University Hospital (RWJUH) Hamilton.

Taking numerous drugs is often necessary to manage chronic conditions such as heart disease, diabetes or kidney disease. The practice can happen at any age but occurs most often among older adults, who are most likely to have multiple health conditions. It’s not unusual for people to take five to seven medications, and some people take 12 to 15 or even more, Dr. Ali says. But problems can arise when these medications start causing more harm than good and are not stopped after treatment completion.

Polypharmacy can lead to potentially troublesome or even dangerous drug interactions or side effects. “Polypharmacy is very common and something I’m always talking about with my patients,” Dr. Ali says. “A lot of issues can result, like falls, fractures, emergency room visits and hospitalizations. For some people, the whole cascade can lead from hospital to nursing home and go downhill from there.”

In many cases, patients can work with their doctors to manage side effects and reduce risks by adjusting doses, tracking compliance, fine-tuning which specific medications are prescribed or, in some instances, even eliminating unnecessary drugs from a regimen.

Common Interactions

Polypharmacy doesn’t just involve prescription drugs. Over-the-counter remedies such as aspirin, acetaminophen, naproxen or ibuprofen count, too, as do supplemental vitamins and herbs. National survey data suggest that nearly two-thirds of older Americans use dietary supplements, but many don’t mention this to their doctors. “Sometimes patients don’t categorize these as medications when they’re not prescribed by a physician, but that doesn’t mean they’re completely harmless,” Dr. Ali says.

Some of the most common polypharmacy offenders among prescription drugs include sleeping pills or sedatives such as benzodiazepines; certain pain relievers, including opioids; some older antidepressants; and heartburn medications.

The combined effects of multiple medications can be especially harmful to older people, who tend to metabolize drugs slower than younger people. Kidney and liver function change with age, which can trigger new or recurring side effects such as drowsiness, dizziness, constipation or diarrhea, confusion, weakness, anxiety and appetite loss.

“People often believe older age itself is why they’re feeling tired, dizzy or drowsy, but it could actually be side effects from drug interactions,” Dr. Ali adds. “And side effects can start happening at any time, even if you’ve been taking a medication for a long time.”

Proactive Solutions

Knowing these risks, Dr. Ali takes a proactive approach with patients, routinely reviewing their full list of medications and supplements to determine if any might be problems or even unnecessary. She recommends frequent, open discussions with your doctor to tackle challenges stemming from medication use so that drugs or doses can be adjusted to minimize side effects while maintaining desired results. “I often explain to patients, ‘I’m not decreasing your dose so the medication is less effective,’” Dr. Ali says. “‘I’m doing it because taking less is just as effective for you.’”

Often, Dr. Ali can suggest alternate ways of delivering a medication that can alleviate side effects. For example, it may be possible to use a topical ointment instead of an oral medication. Using combination drugs, which wrap two or more medications into a single pill, can also help patients stay on track with regimens and lower overall medication intake.

But it’s important not to adjust or, especially, quit a medication without consulting a physician. “It’s always an ongoing conversation—we build trust together,” Dr. Ali says. “Some medications we can easily stop altogether and others we can taper off slowly. It’s a partnership.”

If you see multiple specialists for various health problems, make sure each knows the complete list of medications you take, including vitamins and other supplements. Ideally, one doctor—such as a geriatrician—should oversee your care, taking all your conditions and medications into account.

“Sometimes patients don’t know that we can make changes to their medications and they’ll not only be totally fine but benefit from this,” Dr. Ali says. “Most of the time, they ’re excited by the idea and want to talk about it.”

Better Health Events Broach Amending Medications

When geriatrician Sara Ali, MD, speaks at a Better Health event at RWJUH Hamilton, medication management often becomes the focus. She says the topic is so relevant to Better Health Program members—many of whom take multiple medications to manage chronic conditions—that new questions are constantly popping up. “We always get a good audience at these talks,” Dr. Ali says. “It’s interesting and important to address specific questions and cases there.”

On December 2 from 1 p.m. to 2 p.m., Dr. Ali will present “Let’s Talk Vitamins,” a program that will separate fact from fiction and provide information on what works and what doesn’t.

The Better Health Program is a free membership program that RWJUH Hamilton offers to people ages 65- plus—at no cost—that helps them meet like-minded people and learn from doctors and other professionals. Better Health programs touch on both fun and serious matters, including travel, finances, spirituality and various health conditions. Dr. Ali’s seminar topics have included diabetes, preventive care, gait impairment and falls, and vision and hearing, among others.

To join the complimentary Better Health Program at RWJUH Hamilton, call 609-584-5900.