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A KFF Health News report describes growing concerns about medication interactions as more older adults take several prescriptions. Clinicians and pharmacists interviewed recommend keeping an up-to-date list of medicines and supplements and discussing side effects or possible deprescribing with a health professional; patients should not stop medicines on their own.
A KFF Health News report highlights the risks of taking multiple medications and urges people who notice side effects or have concerns about their prescriptions to discuss a medication review with a clinician. The report describes a Pennsylvania man whose doctors found that a drug interaction was damaging his liver, and notes that more than a third of adults over 65 take five or more medications a day.
Jonathan Bledsoe of Reading, Pennsylvania, took medication to stabilize his mood and control cholesterol, along with several other medicines. After he noticed that his urine had turned dark, he raised the symptoms with his doctors. They found that an interaction between his medications was beginning to damage his liver, according to the report. After his medicines were changed, his liver and kidney function returned to normal.
The report cites a study published in JAMA Internal Medicine that found the share of Americans over 65 taking five or more medications nearly doubled from 2000 to 2020. Hospitalist and Vanderbilt University associate professor Amanda Mixon said she sees older patients taking an average of 16 medications, often prescribed by multiple clinicians and filled at different pharmacies. More medicines can mean more opportunities for interactions and side effects, she said.
One concern is a prescribing cascade: a medicine causes a side effect, another medicine is prescribed to address it, and further symptoms may prompt additional prescriptions. Pharmacist DeLon Canterbury told the report that clinicians do not necessarily have access to a complete list of medicines prescribed by other providers, particularly across separate health systems. The report advises patients to keep an updated list of prescriptions, vitamins and supplements and bring it to appointments.
Medication Reviews Can Catch Interactions
The issue matters because medication plans can grow over time, while responsibility for prescribing may be spread among several clinicians. A provider who does not know about another prescription or supplement may not see the full combination. The report does not say that taking several medicines is always inappropriate; rather, it describes how a review can help determine whether each medicine remains suitable and whether side effects or interactions need attention.
Deprescribing means intentionally reducing or stopping a medication when a clinician and patient determine it is no longer needed or its risks outweigh its benefits. Canterbury said the goal is patient safety, not reducing medication counts for their own sake. Because some medicines require a gradual dose reduction, patients should seek professional guidance rather than stop or change a prescription independently.
The process can also take time. The report says the science and practice of safely tapering medicines are relatively new and are not yet widely taught in medical schools, according to Canterbury. CMS issued guidance this year clarifying how physicians and pharmacists can be paid for medication reviews and help with tapering when appropriate. That could address uncertainty providers previously reported about reimbursement for the work.
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How Multiple Prescriptions Accumulate
Multiple medications may be prescribed by different specialists or primary care providers as a person’s health needs change. A medicine added to treat one condition can cause an effect that resembles a new problem, or can worsen another condition. In the example Mixon gave, a water pill prescribed for heart failure can increase urination; incontinence may then be treated with another medicine. The report presents this as one example of how a prescribing cascade can develop, not as a claim that such treatment is always unnecessary.
Medication effects can also change with age. Canterbury said the body may process medicines differently as people get older, raising the likelihood of side effects such as constipation, diarrhea, falls or memory problems. The report recommends including over-the-counter products, vitamins and supplements on a medication list, since clinicians need a full picture when reviewing a regimen.
The report also notes that there is no automatic check guaranteed to catch every interaction. Canterbury cautioned that patients should not assume a pharmacy or prescriber has reviewed every medicine from every provider. A current paper list can be a practical way to share that information, even for people who also use medication-tracking apps.
““As you accumulate more and more medications, the chance of them interacting with each other and having bad interactions increases.””
— Amanda Mixon, hospitalist and Vanderbilt University associate professor
What a Review Can Establish
The report does not quantify how many medication-related problems could be prevented through reviews, or provide a national count of patients affected by harmful interactions. The cited study establishes a change in the share of older adults taking five or more medicines from 2000 to 2020, but does not by itself show that every person taking that many medicines faces harm.
It is also not clear how widely clinicians will use the newer CMS payment guidance or whether it will lead to more medication reviews. The report describes the guidance as clarifying payment, but gives no figures on claims, provider participation or patient outcomes. Nor does it identify a single method or schedule for tapering: decisions depend on the specific drug and the patient’s circumstances.
Bring a List to Your Next Visit
People concerned about a medication, a new symptom or an unexpected side effect can bring an updated list of prescriptions and supplements to a primary care clinician or specialist and ask whether each item is still needed. They can also ask whether medicines prescribed by different providers may interact and whether any could be reduced safely. The report advises starting a conversation, not stopping a medicine without guidance.
Clinicians and pharmacists can then review the full regimen and determine whether a change or taper is appropriate. How often that happens, and whether the new CMS guidance affects access to such reviews, remains to be seen. The immediate practical step described in the report is to keep the medication list current and share it whenever care is discussed.
Key Questions
What does deprescribing mean?
Deprescribing is the intentional process of reducing or stopping a medicine when a patient and clinician determine it may no longer be needed or may pose more risk than benefit. Some medicines need to be tapered under professional supervision.
Should I stop a medication if I think it is causing side effects?
No. Contact the clinician who prescribed it or another qualified health professional to discuss the symptom and the medicine. Do not stop or change a prescription on your own, since the safe approach depends on the drug and your health situation.
What should I put on a medication list?
List prescription medicines, over-the-counter products, vitamins and supplements, and keep the information current. Bring it to appointments so providers can review medicines prescribed by different clinicians.
Does taking five or more medicines mean someone is being overtreated?
No. The report uses five or more medicines as a measure of polypharmacy, but that number alone does not establish that treatment is inappropriate. A clinician should review the person’s conditions, medicines, benefits and risks.
Source: rss
