A Brief Look at Polypharmacy: Drug Therapy for the Elderly

A brief conversation with Stephanie Yager, PharmD, and Marigel Constantiner, RPh, MSc, BCPS, CGP, CPh

How many prescriptions is too many—or when should you begin to worry about polypharmacy?

Patients require a wide range of medications depending on their comorbidities. The minimum number of medications used to define polypharmacy is variable, but is frequently defined as the concomitant use of five or more drugs. The concomitant use of 10 or more dugs has been termed excessive polypharmacy. One retrospective study concluded that clinicians should suspect high risk of potentially inappropriate medication use in older outpatients with five or more prescription medications.

Advanced age and polypharmacy are risk factors for adverse drug-event related healthcare visits. Appropriately managing polypharmacy has the potential to reduce avoidable healthcare expenditures. The majority of adverse drug events are attributed to four medication classes: warfarin, oral antiplatelet agents, insulins, and oral hypoglycemic agents.

Overall, there is no magic number for how many prescriptions is too many, but we begin to worry about polypharmacy when a patient is on five or more medications. As patients age, it is important for physicians and pharmacists to regularly evaluate a patient’s medication list to ensure that all medications are in line with their goals of care.

Stephanie Yager, PharmD, is an ambulatory care pharmacy resident at Cleveland Clinic’s main campus.

Marigel Constantiner, RPh, MSc, BCPS, CGP, CPh, is specialized as a drug information pharmacist and preceptor at Cleveland Clinic with a special interest in geriatrics. She can be reached at constam@ccf.org or 216.444.1126.

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