The Janus face of polypharmacy – overuse versus underuse of medication

Abstract

As modern guidelines may recommend several drugs for a single medical condition, it follows that many patients, especially if co-morbidity is present, use a number of medications. Also, an aging population implies more morbidity and consequently will have the result that many patients use many drugs -a situation often referred to as polypharmacy. Polypharmacy has been linked to negative health outcomes such as adverse drug reactions, interaction problems, poor patient adherence, and hospitalisations. Such experiences have led to the attitude that efforts should be made to reduce polypharmacy. However, this approach might prevent patients from obtaining optimal treatment. There is no universal definition of polypharmacy and measuring of a reduction in polypharmacy becomes problematic. Because polypharmacy is an imprecise term it should be used with caution in research as well as in patient management. Moreover, studies have shown that undertreatment occurs frequently also among patients using many drugs. This is the Janus face of polypharmacy: too many drugs should be avoided, but the individual patient should receive the appropriate drugs that have the potential to reduce morbidity and improve quality of life. It is the individual drugs themselves, along with patient specific factors, and not a fixed number of drugs, that we should pay attention to.

A cross-sectional evaluation of the prevalence and detection of predictors of polypharmacy amongst adult in Spain

“…It has been estimated that between 4 and 34% of individuals aged 65 years or more are on polypharmacy regimes . Polypharmacy has been associated with sociodemographic factors (age, gender, education, employment and socio‐economic status), influence of disease (multimorbidity, poor self‐reported health status and chronic illness) and health system factors (number of prescribers, perceived patient pressure or publically funded health care) . Several strategies promoted by community pharmacists have shown a reduction in the level of non‐adherence in patients on a polypharmacy regime and have been able to identify several drug‐related problems in older patients on a polypharmacy regime …”

“…[3] Polypharmacy has been linked to negative health outcomes such as adverse effects of medication, drug interactions, duplication of therapy, poor patient adherence to treatment and an increasing number of hospitalizations. [2,[4][5][6][7] However, polypharmacy is sometimes unavoidable, as many conditions and/or patients may require a combination of several medicines to achieve the greatest possible benefit. [8] It has been estimated that between 4 and 34% of individuals aged 65 years or more are on polypharmacy regimes.…”

“…[4] Polypharmacy has been associated with sociodemographic factors (age, gender, education, employment and socio-economic status), [2,[9][10][11] influence of disease (multimorbidity, poor self-reported health status and chronic illness) and health system factors (number of prescribers, perceived patient pressure or publically funded health care). [4,7,[11][12][13] Several strategies promoted by community pharmacists have shown a reduction in the level of non-adherence in patients on a polypharmacy regime [14] and have been able to identify several drug-related problems in older patients on a polypharmacy regime. [15] Although polypharmacy has been studied especially in older people as ageing implies greater morbidity, often resulting in the use of many different medicines, there are few studies in other age groups.…”

Factors associated with statin-related adverse muscular events in adult dyslipidemic outpatients

“…Polypharmacy has been associated with adverse health events such as side effects, drug interactions, low adherence to treatment, hospitalization and costs related to the treatment of its complications (Viktil, Blix, Reikvam, 2008). Thus, the potential for drug interactions that may increase statin bioavailability is a relevant factor for the appearance of AME (Bellosta, Paoletti, Corsini, 2004;Thai et al, 2016).…”

Polypharmacy in patients who are using EMS Belgrade services

“…У неким се пак радовима код дефиниције полифармације не наводи број употребљених лекова, већ се она дефинише као употреба лекова више него што је то медицински оправдано 19 . Због значајних, а некада и веома опасних потенцијалних ризика који постоје код употребе великог броја лекова и лековитих средстава, све је већи број оних који сматрају да у дефиницији полифармције није битан само број, већ присуство других фактора ризика, присутних других оболења и здравственог стања сваког појединца 20,21 . У нашем раду смо полифармацију дефинисали као истовремено коришћење шест или више лекова у последњих седам дана, повремено или стално.…”