polypharmacy.pptx by dr. saurabh maurya

“One of the first duties of the physician
is to educate the masses not to take
(inappropriate) medicines”.

Content :
 Definition
 Epidemiology
Reasons of polypharmacy
Types
 Controlling Measures
 Strategies and roles
 Conclusion

Definition :
According to WHO
“Polypharmacy is defined as the administration of many drugs at the
same time or the administration of an excessive number of drugs.”
• In terms of the number of medications, polypharmacy is the use of
five or more medications daily (this includes OTC drugs, prescription,
traditional, and complementary medicines used by patients).

Epidemiology :
 Most common in geriatric patients ( because often they suffer
from chronic diseases with concomitant pathologies).
 Prevalence in India: 33%
Uttarakhand and Karnataka have the highest prevalence among
states.

Synonyms:
 Polymedication
 Poly-prescription
 Multi prescription
 Multimedication.

Other Terms related to polypharmacy:
• - Rational use of drugs
1. Appropriate / Therapeutic polypharmacy
• Irrational use of drugs
2. Inappropriate / Contra-therapeutic polypharmacy
• - False reporting of consumption of medicines
3. Pseudo-pharmacy

Classification :
1. Same-class polypharmacy –
Use of more than one medication from the same class.
eg. - Two SSRIs such as Fluoxetine and Paroxetine
2. Multi-class polypharmacy –
Use of more than one medication from different classes.
eg. – Lithium with an atypical antipsychotic (olanzapine)
ACEI with CCBs

3. Adjunctive polypharmacy –
use of one medication to treat side effect of another
medication from different class.
eg. – Antibiotics with Probiotics
Bupropion with Trazadone
4. Augmentation polypharmacy –
use of medication at lower dose with other medication from
different class at full therapeutic dose for same symptom.
eg. – addition of low dose haloperidol in a pt responding
partially to risperidone.

5. Total polypharmacy –
- It is total count of medications used in a patient
or total drug load.
- It includes prescription medication , OTC drugs,
alternative medical therapies.

Reasons for polypharmacy –
1. Elderly patients
2. Patients with multiple comorbidities
3. Self-medication with OTC drugs
4. Multiple doctors
5. Prescribing cascade
6. Patient’s non-adherence
7. Lack of patient education
8. In-effective communication

Outcomes of polypharmacy –
Negative outcomes –
1) Interactions – Drug- Drug interaction , Drug – food interaction
Drug – alcohol interaction
2) Adverse effects
3) Inappropriate treatment
4) Non-adherence
5) Increase treatment expenditure

Positive outcomes :
1. Synergistic combination –
- allows lower doses so less adverse effects.
- eg. – Treatment of hypertension
2. Supplemental drug may decrease adverse effect
- eg. – anticholinergics added for drug induced
extrapyramidal symptoms.

3. Additional drug may approve outcome.
eg. – spironolactone added with ACEI for heart failure.
4. Multiple drugs may be needed for multiple conditions.
eg. – DM with HTN
Economic impact of polypharmacy :
• Increase in medicine expenditure.
• Chances of hospitalization and exposure to multiple doctors
increase which leads to high economic burden.

Controlling Measures :
1) Maintain an accurate medication and medical history
- having a complete list of medications can deter a doctor
from adding a new drug.
2) Link each prescribed medication to a disease state
- any medication that does not match a diagnosis should be
discontinued.
3) Identify medications that are treating side effect

• Use of multiple medication leads to a higher risk of side effects.
• When side effects occur, addition medicine can be initiated.
• Eg. –
1- use of laxative to treat medication side effect of constipation.
2 – use of sleeping medication to treat insomnia caused by
theophylline and prednisone.
4) Initiate interventions to ensure adherence
• using combination drug will reduce pill number.
• Use generic drug to reduce cost.

Preventions :
1) Use of appropriate medications
2) Drug which is unnecessary, inappropriate should be avoided.
3) Drugs having high likelihood for causing side effects should be
avoided.

Role of Physician to reduce polypharmacy :
1. Determine all medications being taken.
2. Indentify indication for all medications.
3. Identify any potential for adverse effect for each medication.
4. Recommend eliminating medication with no benefit, goal.
5. Recommend substituting medication with lesser side effect.
6. Use medications with less frequent dosing schedule.
7. Avoid utilizing another medication to treat side effect of another agent.

8. Keep drug regimens as simple as possible.
9. Review all medication profiles regularly.
10. Encourage the patient to follow up regularly.
11. Encourage patient to carry the list of their medication to every
physician.

Role of Consumer:
1. Get involved in his own health.
2. Should not be afraid to ask questions.
3. Patients should know the name and indication of each drug.
4. Ensure dietary/herbal supplements are safe before taking.
5. Proper storage of medication.

Roles of pharmacists:
• Hospital pharmacist – Review the complete and accurate list of
patients medications.
• Long-term care pharmacist – to evaluate drug therapy regimen in
predominantly elder patients.
• Community pharmacist – preventing the dispensing of unnecessary,
inappropriate and side effect prone medications.

Strategies to avoid polypharmacy:
ARMOR – Assess medication
- Review for possible interaction
- Minimize nonessential medications
- Optimize dosing
- Reassess patient for clinical status and adherence.
- Tool to evaluate polypharmacy in older adults.
- A systematic and organized step wise approach.

Conclusion:
• Polypharmacy is a problem of substantial importance.
• It is a preventable problem mostly.
• Interventions like reducing the number of medications,
increase patient adherence, preventing ADRs are the main tool
to combat polypharmacy.

References:
• Priya S, Gupta NL, Chauhan HS. Polypharmacy – Prevalence and risk factors among elderly
patients in government medical college, Tanda, Distt Kangra (HP) [[Last accessed on 2019 Jun
13]]. Available from: https://gmch.gov.in/community%20medicine/IPHA_Vol%203_No9.pdf
• Rituparna Maiti, Post-graduate Topics in Pharmacology, 3rd
edition, Paras Medical Books 2020
• Sarkar S, Srivastava V, Mohanti M. Postgraduate pharmacology, 1st edition Paras Medical Books
2020

polypharmacy.pptx by dr. saurabh maurya

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