Polypharmacy in Clinical Practice

Pharmacotherapy is undoubtedly the most common clinical intervention for many disease conditions. While it can be highly effective in treating diseases or slowing disease progression, there are often concerns raised regarding the inappropriate use of drugs. This can lead to adverse drug reactions (ADR) and drug-drug interactions (DDI). The term polypharmacy means “multiple medications” and is considered to be present when a patient takes five or more medications. It may be “appropriate polypharmacy” when all drugs are prescribed for specific therapeutic objectives and the drug therapy has been optimised to minimise the risk of ADR. However, on occasions “inappropriate polypharmacy” might be present, when one or more drugs are prescribed that are no longer needed, and the combination of several drugs puts the patient at an unacceptably high risk of ADR.

Inappropriate polypharmacy is a clinical concern since the risks due to medications outweigh benefits for the individual patient. Rational prescribing should address this through identifying patients at greater risk of harm and deciding a medication regimen that is tailored to their changing needs and expectations. The importance of polypharmacy management is recognised worldwide. The recent WHO Third Global Patient Safety Challenge “Medication without Harm” aims to reduce severe avoidable medication related harm by 50% over 5 years, globally [1]. The EU funded project SIMPATHY [2] has been studying polypharmacy management in Europe and has identified recommendations to improve medication safety.