For nearly three years, Jonathan Bledsoe of Reading, Pennsylvania, took one prescription to stabilize his mood and one to keep his cholesterol in check, among a handful of other medications.
“You wouldn’t think you would have to be your own advocate and look out for yourself as far as managing your medications,” the Marine veteran said. “But when you wake up one morning and what you pee comes out the color of fresh brewed coffee, there’s an issue.”
He took his concerning symptoms back to his multiple doctors and learned the interaction between his medications was starting to damage his liver. After he changed medications, his liver and kidney function returned to normal.
Adverse drug interactions are becoming a bigger health concern as more people take multiple medications, said Amanda Mixon, a hospitalist and associate professor of bioinformatics at Vanderbilt University.
The percentage of Americans over 65 taking five or more medications, known as polypharmacy, nearly doubled from 2000 to 2020, according to a study published in JAMA Internal Medicine. Now, more than a third of older adults are taking five or more medications a day.
Mixon said she sees older patients with an average of 16 medications, often from multiple prescribers and pharmacies.
“As you accumulate more and more medications, the chance of them interacting with each other and having bad interactions increases,” Mixon said. “As these medications get added sort of progressively, that can accumulate over time, and then people are having more side effects.”
The QTip:
If you’re taking medications and supplements, keep your own up-to-date list and have it with you.
If you’re concerned about your medications, here’s what to know:
There’s No ‘Unicorn Pharmacist’
Sometimes, a medication intended to treat one issue leads to many more, known as a “prescribing cascade”: A prescription for the initial symptom causes a side effect, then that side effect needs to be treated. Eventually, the combination of meds may cause other issues that require yet another medication.
For instance, Mixon said, heart failure patients take a water pill to reduce fluid retention. As a result, the constant need to urinate can lead to incontinence, which is treated by another medication.
“We do an amazing job of treating. We are great at diagnosing, and medicines have an amazing role in increasing our longevity as humans,” said pharmacist DeLon Canterbury. He’s the CEO of the North Carolina-based consulting company GeriatRx, which focuses on helping patients get off unnecessary medications. “It’s not the intent of our providers to overtreat. It’s just what we’ve been trained to do.”
When multiple prescribers are involved, they may not be aware of the patient’s other medications, he said, especially if the health providers are affiliated with different health systems that have separate patient records.
“Do not assume that someone is checking all of these things in the background. There isn’t this magical unicorn pharmacist just making sure everything is safe. Yes, even at the local pharmacy,” Canterbury said. “So make sure, if you notice something is off, that you advocate for yourself.”
A Shift Toward ‘Deprescribing’
“Deprescribing,” the process of intentionally tapering off medications, has gained more momentum in the past decade, alongside the corresponding rise of polypharmacy and the associated health risks.
The science on how to taper patients safely is newer and still not widely taught in medical schools, Canterbury said.
He said patients who are worried about taking multiple medications — especially people experiencing a new symptom or an unexpected side effect — should start a conversation about deprescribing with their specialists or primary care providers.
“I promise you, they don’t bite,” he said. “Because you’ll be surprised that the more you bring up stopping a medication, the more willing they are to actually have that dialogue and help you get off of it if you don’t need it.”
The goal isn’t kicking as many meds as possible, Canterbury said — it’s patient safety. With age, bodies metabolize medications differently, he said, increasing the likelihood of harmful side effects like constipation, diarrhea, falls, and memory loss.
Keep a Medication List
Many pharmacists and doctors agree on the value of keeping an updated medication list, including the vitamins and supplements you’re taking. While there are QR code bracelets and medication tracking apps, sometimes the easiest strategy is an old-fashioned piece of paper.
“Everyone needs a medication list in their pocket,” said pharmacist Jen Hammons, director of rural health advancement at the Appalachian College of Pharmacy in Virginia. “If you can’t commit it to memory, you need to have a list.”
People and Policy
Health and Human Services Secretary Robert F. Kennedy Jr. has championed weaning Americans off psychiatric medications that he says are overused, a stance that has polarized the medical community. This year, the Centers for Medicare & Medicaid Services released guidance that clarifies how physicians and pharmacists can be paid for their work reviewing medications and helping patients taper off when appropriate. Previously, physicians reported uncertainty over whether they could get paid for deprescribing, which can be a time-intensive process.
Katherine Ruppelt and Emily Siner at Nashville Public Radio contributed to this report.
HealthQ is a health series from reporters Cara Anthony and Blake Farmer, approachable guides to an unapproachable healthcare system. It’s a collaboration between Nashville Public Radio and KFF Health News.