Polypharmacy is the concurrent use of multiple medications bya patient.It is most common in the elderly, affecting about 40% of older adults living in their own homes. About 21% of adults with intellectual disability are also exposed to polypharmacy. Polypharmacy is not necessarily ill-advised, but in many instances can lead to negative outcomes or poor treatment effectiveness, often being more harmful than helpful orpresenting toomuch risk for too little benefit. Therefore, health professionals consider it a situation that requires monitoring and review to validate whether all of the medications are still necessary. Concerns about polypharmacy include:increased adverse drug reactions, drug interactions, prescribing cascading, and higher costs. Polypharmacy is often associated with a decreased quality of life; including decreased mobility and cognition.
World Health Organization has evaluated that in every nine people there is one elderly person, i.e. of age 60 years or older. This value is expected to increase to one in five people by 2050 accounting for about half of the total growth of the world population.
There is no standard definition of polypharmacy as such. It can be explained as the use of multiple medications generally referred to five or more prescribed drugs per day and/or the administration of more medications than are clinically indicated, representing unnecessary/unwanted drug use.Various studies globally have shown thatan average 2-9 medications per day are taken by the elderly. The prevalence of inappropriate medication used by an elderly person was found to be from 11.5-62.5%.
Polypharmacy is an area of concern for the elderly because of several reasons. Elderly people are at a greater risk for adverse drug reactions (ADRs) because of the metabolic changes and reduced drug clearance associated with ageing; this risk is furthermore exacerbated by increasing the number of drugs taken.
Identifying and avoiding the polypharmacy can lead to better outcomes in the elderly patients and also helps in improving the quality of life. Medication review is an essential part in the elderly patient to avoid adverse effects that can be caused due to polypharmacy.
A drug interaction can be defined as an interaction between a drug and another substance that prevents the drug from performing as expected. This definition applies to interactions of drugs with other drugs (drug-drug interactions), as well as drugs with food (drug-food interactions) and other substances.
Whenever two or more drugs are being taken, there is a chance that there will be an interaction among the drugs. The interaction may increase or decrease the effectiveness of the drugs or the side effects of the drugs. The likelihood of drug interactions increases as the number of drugs being taken increases. Therefore, people who take several drugs are at the greatest risk for interactions. Drug interactions contribute to the cost of healthcare because of the costs of medical care that are required to treat problems caused by changes in effectiveness or side effects. Interactions also can lead to psychological suffering that can be avoided.
The drug interaction between Warfarin (Coumadin) and vitamin K-containing products is a good example of this type of interaction. Warfarin acts by reducing the concentration of the active form of vitamin K in the body. Therefore, when warfarin is taken with vitamin K, the effect of vitamin K is reduced.
What Are The Consequences Of Drug Interactions?
Drug interactions may lead to an increase or decrease in the beneficial or the adverse effects of the given drugs. When a drug interaction increases the benefit of the administered drugs without increasing side effects, both drugs may be combined to increase the control of the condition that is being treated. For example, drugs that reduce blood pressure by different mechanisms may be combined because the blood pressure lowering effect achieved by both drugs may be better than with either drug alone.
The absorption of some drugs is increased by food. Therefore, these drugs are taken with food in order to increase their concentration in the body and, ultimately, their effect. Conversely, when a drug’s absorption is reduced by food, the drug is taken on an empty stomach.
Drug interactions that are of greatest concern are those that reduce the desired effects or increase the adverse effects of the drugs. Drugs that reduce the absorption or increase the metabolism or elimination of other drugs tend to reduce the effects of the other drugs. This may lead to failure of therapy or warrant an increase in the dose of the affected drug. Conversely, drugs that increase absorption or reduce the elimination or metabolism of other drugs – increase the concentration of the other drugs in the body – and lead to increased amounts of drug in the body and more side effects. Sometimes, drugs interact because they produce similar side effects. Thus, when two drugs that produce similar side effects are combined, the frequency and severity of the side effect are increased.
How Can Drug Interactions Be Avoided?
- Give health care practitioners a complete list of all of the drugs that you are using or have used within the last few weeks. This should include over-the-counter medications, vitamins, food supplements, and herbal remedies.
- Inform health care practitioners when medications are added or discontinued.
- Inform health care practitioners about changes in lifestyle (for example, exercise, diet, alcoholintake).
- Ask your health care practitioners about the most serious or frequent drug interactions with the medications that you are taking.
- Since the frequency of drug interactions increases with the number of medications, work with your health care practitioners to eliminate unnecessary medications.