13 Signs You Are Taking Too Many Prescriptions
If you have two or more chronic conditions such as depression, high blood pressure, diabetes, cancer, congestive heart failure, or asthma, chances are you're taking a number of prescription medications. And you're not alone. According to the Centers for Disease Control and Prevention (CDC) (via the National Institute on Aging), about one in every five adults in the United States between the ages of 40 and 79 uses at least that many prescription drugs on a regular basis.
Taking five or more prescription medications is called polypharmacy, and it may put you at risk of harmful drug interactions (via PM&R Knowledge NOW). Polypharmacy is also defined as taking 10 or more medications, or prescriptions you don't need, or duplicates of a type of medicine, or not taking medications as prescribed.
Particularly in older adults, polypharmacy can cause drug toxicity, overdosing, underdosing, falls that cause injuries, and hospitalizations, per a paper published in the Mayo Clinic Proceedings. According to the CDC (via Yale Medicine), common drugs that are especially prone to result in hospitalizations include blood thinners, opioid analgesics, and medications that need frequent monitoring with blood tests.
But wait! Don't stop taking any of your medications after reading these few paragraphs, as you may actually need all of them. But there's also a possibility that there are a few you could eliminate after talking to your doctor or pharmacist.
You're taking medications prescribed by more than one doctor
You may be receiving care from several doctors, each managing one or more of your conditions, and that's fine (via CBS Austin). But it may also mean that you're taking too many prescription medications because one doctor doesn't know what another doctor has prescribed and may order a duplicate. What's more, without knowing everything you're taking, your doctors can't advise you on possible drug interactions, or suggest changes you should make.
According to the U.S. Food and Drug Administration (FDA) (as cited by CBS Austin), more than 2,000,000 adverse drug reactions (ADRs) take place in the United States each year, resulting in 100,000 deaths. Surely, you don't want to become one of those statistics!
To maximize your safety, no matter how many drugs you're taking, keep a current list of all your prescription medications, over-the-counter drugs, vitamins, and supplements — yes, absolutely everything you're taking — and share it with each of your doctors at every visit. Your list should include the name of each medication, the dosage, the frequency that you're taking it, and why you're taking it. If you've been on a certain type of medication a long time, you may have even forgotten its purpose, and may not need it anymore.
You deliberately try to beat the system by double doctoring
Double doctoring (or doctor shopping) is when you seek care from multiple doctors without the other doctors' knowledge, so you can get a certain type of medication or a larger supply of one medication (via a paper in Innovations in Clinical Neuroscience). Certainly, you wouldn't do this, but some people aren't entirely honest about their current prescriptions so that they can get duplicates or additional prescriptions from an online source. Some people also exaggerate their symptoms with a secondary doctor, so they can get a larger dose or quantity of a medication and even get enough to sell.
This practice, which is especially common with drugs like painkillers and tranquilizers, obviously puts you at risk of drug interactions, overdosing, and addiction. But another downside is that doctors are increasingly distrustful of patients who request these medications, and may end up under medicating people who legitimately need the prescription drugs.
Over and above your health and safety, doctor shopping that involves lying or concealing facts to obtain narcotic drugs is against federal law, says the American Addiction Centers, and can result in prison time and multi-thousand-dollar fines if you're caught. Something to avoid, right?
You're getting your prescriptions from more than one pharmacy
If you frequent multiple pharmacies while looking for the best prices, the most convenient locations or hours, or pharmacies that accept your insurance, you may be taking too many medications. Like your doctors, multiple pharmacists probably don't have a thorough understanding of everything you're taking, so you're missing out on the essential check they routinely provide for possible drug interactions or duplications, says SpotRx Pharmacy.
Choosing just one pharmacy and sticking with it whenever possible has several benefits. Your pharmacist can explain what your medications are treating, how to take them, possible side effects to watch for, and what to do if you experience unexpected symptoms (via the CDC).
Assuming your pharmacist has a complete list of all the medications you're taking, they can help you choose over-the-counter medicines that you can safely take with your prescription medications. They can offer advice on how to use things like inhalers and blood glucose monitors. And they can answer important questions (like if you should avoid driving or eating certain foods while you're taking the medication).
You have lost track of – or never knew – the foods and beverages you shouldn't consume with your medications
Some foods and beverages can interfere with the way your body either absorbs or eliminates prescription and over-the-counter medications, according to Johns Hopkins Medicine. For example, fruit juices may minimize the healing properties of antibiotics, and dairy products may decrease the effectiveness of tetracycline, which is used to fight infections and control acne (via the Mayo Clinic). And using alcohol or tobacco with certain medications can cause unwanted interactions.
Monoamine oxidase inhibitors, known as MAO inhibitors or MAOIs, which are commonly prescribed as antidepressants, can be dangerous when consumed with aged cheese and cured meats (via Drugs.com), as well as other foods that are high in tyramine, says Everyday Health. These include pickled herring, fava beans, and certain types of wine. Mixing Tylenol (acetaminophen) and alcohol can put you at risk of liver toxicity; licorice – in candy, tea, supplements, and tobacco — can render the diuretic Aldactone ineffective; and vegetables that are high in vitamin K, like kale and broccoli, eliminate the blood clotting properties of medications like warfarin.
A drug interactions checker (via Drugs.com) lets you check each of your medications for possible interactions. Drugs.com also offers mobile apps that can help you identify pills and get additional drug information.
You're over age 65 and still taking medications like you did 25 years ago
Your body's ability to absorb, distribute, metabolize, and excrete medication declines as you get older, as well as your sensitivity to various drugs, says Technology Networks. Body fat increases, trapping medications so they remain in your body longer (via the British Journal of Pharmacology), and muscle mass decreases (via Nutrition). Since muscle cells store more water than fat cells, you experience a decreased ability to dissolve water-soluble medications. Decreases in digestive system, liver, and kidney function can also result in decreased effectiveness of medications, and for them to collect in your organs.
What all this means is that you may need a lower dose of a medication, or a different medication that is safer for you as you get older (via HealthinAging.org). The American Geriatrics Society's Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (via Guideline Central) provides a thorough list of medications that you and your doctor may want to reconsider. For example, taking opioids may put you at increased risk of extreme sedation that can lead to respiratory depression and even death.
You're having trouble taking your medications as prescribed
You may be taking too many prescription medications if you find it challenging to keep track of the dosages and frequency of each medication (via AgingCare). About 55% of older adults don't comply with their medications' recommended use, says the Department of Health and Human Services, and around 200,000 older adults land in the hospital every year as a result of adverse drug reactions.
Problems with taking your medications as you get older can be exacerbated if your memory declines, leading to you forgetting whether you've taken a medication or not, or you have vision problems that make it hard to read labels on prescription and over-the-counter medications. Difficulty swallowing pills, or hearing loss that makes it hard to understand a doctor or pharmacist's instructions, can also contribute to medication non-adherence.
The more medications you're taking, the higher the risk of noncompliance, and that can decrease the benefits of your treatment and cause a deterioration of your health conditions, says the Journal of Clinical Gerontology and Geriatrics (via ScienceDirect).
You experience one or several symptoms of adverse drug interactions
Signs of medication side effects or interactions can take many forms, and you may not even recognize them as being related to your medications. For example, you might experience weakness and dizziness, depression, loss of appetite, drowsiness, skin rashes, or diarrhea as a reaction to your medications, says U.S. Pharmacist. Side effects can also be life-threatening, like experiencing a heart attack or liver damage (via the U.S. Food & Drug Administration).
Medication side effects are most likely to occur when you start taking a new drug or supplement, stop taking something you've been on for a while, or increase or decrease the dosage of medications you're on. But they can also occur weeks or even months after you start taking a medication, which makes getting to the bottom of the problem more difficult (via the New York Times). Whenever you notice unexpected symptoms, talk to your doctor. You may be able to adjust the dosage, or try a similar medication that doesn't cause side effects.
To learn more about the possible side effects of the medications you're taking, read the pharmacy label and any information that came with the prescription. You can get additional information on the FDA's Drugs@FDA and FDALabel databases.
You're taking one medication to manage the side effects of another medication
When the side effects of one medication are assumed to be signs of a new medical condition and are treated with an additional medication, you are experiencing a prescribing cascade (via HealthinAging.org).This can lead to more side effects and a continuation of the cascade, and it's most likely to occur if you're seeing multiple doctors.
Dr. Paula Rochon, geriatrician at Women's College Hospital in Ontario, told the New York Times that patients should ask their doctor several questions before starting a new prescription: Is this new drug treating side effects of another medication? Is there a safer drug than the one that's causing the side effects, or would taking a lower dose help alleviate the side effects? And finally: Do I need to take that drug at all? There may be lifestyle changes like cutting back on your sodium intake, losing some weight, or exercising more that can decrease or eliminate your need for the medication.
You're having trouble thinking, concentrating, and remembering
If you're taking too many medications, or medications that have adverse interactions, you may develop what Healthline refers to as medication fog, with symptoms that are similar to dementia and Alzheimer's disease.
This apparent cognitive decline can occur in both young and older people, but young people — with younger brains — can fend off the symptoms better. Medication fog can occur whether you're taking multiple prescription medications or prescription medicines along with over-the-counter drugs, supplements, and vitamins. Just because you can buy these products without a prescription does not guarantee that they're safe.
Over-the-counter medications that put you at high risk of brain fog include antihistamines and sleep medications. According to Yale Medicine, sedative, hypnotic drugs can fog your brain and make your memory worse, and some drugs that calm a younger person can have the opposite effect on an older person. Unfortunately, there often isn't good data available on how certain medications affect older people, because most studies focus on younger people.
You're struggling to pay for multiple prescriptions along with your other expenses
Even if you have good healthcare insurance, most medications have a copay that can cost anywhere from a few dollars to $40 or more. It all adds up, and costs may tempt you to skip medications or take less medication than your doctor prescribes (via Norton Healthcare). But don't do that!
Before making any changes in your medications, talk to your doctor about possible alternatives that may be less expensive, says Dr. Jason L. Crowell, a neurologist specializing in movement disorders at Norton Neuroscience Institute. "As a physician, I want to know if the treatments I prescribe are inducing financial toxicity in my patients. I routinely ask patients about side effects of their medicine, and a drug's cost is often its most significant side effect."
There are numerous ways to cut costs on prescription medications, including switching to a generic form of the drug if one exists, or using drug discount cards or manufacturer coupons. If you're a Medicare enrollee, you may be eligible for its Extra Help program (via Medical News Today). Additionally, some drug companies, nonprofit organizations, or government programs offer help to people who can't afford their medications.
You've been hospitalized in recent months
Research has shown that it's common for a person's medications to be significantly changed during a hospital stay, says Therapeutics and Clinical Risk Management (via the National Library of Medicine). Specifically, a study of more than 10,000 hospitalized patients in Switzerland found that virtually all the patients experienced a median of 3.85 medication changes during their stay, which means half the study participants had more than 3.85 changes and half had less. And, once discharged and returned to their primary care provider's care, the medications were significantly changed again.
Of course it makes sense that medications needed to treat a condition serious enough to send you to the hospital may be unnecessary after you're discharged. But disruption of medication continuity can also contribute to polypharmacy (taking five or more medications at a time), noncompliance with treatment plans, additional costs, and poor health outcomes, especially among older adults.
The University of California Irvine Health published a story about a man in his 70s who ended up with a five-page spreadsheet of his medications after a hospital stay. The hospital had taken away his bag of medications when he arrived, prescribed new medications, then returned his original medications to him when he was discharged. If that happens to you, speak up and ask for help sorting out which medications you should keep taking and which you should throw out.
You take both supplements and prescription medications
Federal research shows that about 72,000,000 people in the United States take supplements along with prescription medications, and in many cases that's just fine. However, certain medications and supplements, when taken together, can be harmful and even life-threatening, says the American Association of Retired Persons (AARP).
For example, high-dose vitamin C can render some types of chemotherapy ineffective, as well as interfere with estrogen levels and the effectiveness of niacin and statins. Probiotics taken within two hours of an antibiotic may reduce the effectiveness of the antibiotic. Turmeric, which has an anticoagulant effect, shouldn't be taken with blood thinners or even aspirin. And Coenzyme Q10 (CoQ10) also interferes with blood thinners, as does ginseng (via WebMD).
Natural Medicines offers a chart that rates various supplement-medication interactions on the basis of minor (be watchful for any side effects), moderate (use caution or avoid), and major (do not use this combination together). Different people respond differently, they say, and you may experience an interaction when another person does not.
You haven't chatted with your doctor about doing some deprescribing
Perhaps you haven't even heard of the term deprescribing, but it refers to a growing trend in the healthcare industry where you and your doctor go through your entire list of prescription drugs, over-the-counter medications, vitamins, and supplements to consider whether you should make any changes (via NPR).
The name is a bit of a misnomer, because the process isn't entirely about eliminating medications. Instead, it's about optimizing your medications — making sure you're not taking anything that can harm you, and also determining whether there's anything that should be added to your medication regime to improve your quality of life. Doctors also look for legacy prescribing, meaning drugs that were prescribed for a short period of time but were never discontinued, says American Family Physician.
As an example of a deprescribing outcome, you and your doctor might agree to eliminate or decrease the dosage of a medication that may be contributing to your memory loss or more frequent falls. The deprescribing conversation works best when there's shared decision-making between you and your doctor: Your doctor offers information and suggestions, you share your opinions, concerns, and preferences, and together, you decide on a plan that you both feel is a good solution.