What is polypharmacy and why is it important?

Medication is by far the most common form of medical intervention for many acute and chronic conditions. Drug therapy can be highly effective in preventing disease or slowing disease progression, with guidelines for single diseases recommending the use of a variety of evidence based drug treatments. However, there is often a mismatch between prescribing guidelines for specific medical conditions and the range of clinical complexity found in individuals. For complex patients with multiple conditions; frailty; a dominant condition (e.g. dementia) or approaching the end of their lives, the implementation of the sum of evidence based recommendations may not be rational, may increase the risk of adverse drug events and may not align with the patient’s preferences.

The term polypharmacy itself just means “many medications” and is defined to be present when a patient takes two or more medications. It is recognised that polypharmacy is often beneficial. For example, secondary prevention of myocardial infarction requires the use of at least four different classes of drugs (antiplatelets, statin, ACE inhibitor, beta blocker).

Appropriate polypharmacy requires consideration at any point of contact involving medication but there are five clear stages which should be used as a trigger to do this:

1. Prescribing (and risk assessment)
2. Medication review
3. Dispensing and administration
4. Communication and patient engagement
5. Medication reconciliation (at care transitions)

Although Polypharmacy Guidance, Realistic Prescribing 2018 concentrates on the holistic patient-centred medication review, the principles, tools and recommendations can be used at any stage, especially at the point of prescribing.