Polypharmacy

Polypharmacy is the use of five or more prescription drugs. In the past eleven years, polypharmacy increased from 10% to 15% for those aged 40-64 years and from 24% to 39% for those over 65 years. Sometimes, the number of daily medications taken by a single patient can be bewilderingly high (e.g., more than 10). As I noted in a recent blog, this is becoming a real issue in my practice. Just imagine the complications for the anesthesiologist assessing the medications and potential interactions prior to surgical intervention.

This data is from a retrospective study from the National Health and Nutrition Examination Survey. It was published in an editorial piece written by Alex Macario, MD in the November 19th issue of JAMA (Journal of the American Medical Association) entitled “Are Americans Taking Too Many Medications?”

Here are a few more statistics for your review:

• The percentage of adults reporting use of any prescription drugs increased from 51% in 1999-2000 to 59% in 2011-2012.
• There was increased use of antihypertensives (from 20% to 27%), antihyperlipidemics (6.9% to 17%) primarily driven by statins; and antidepressants (from 6.8% to 13%).
• Among those interviewed, 4.6% to antidiabetic agents in 1999-2000, which increased to 8.2% in 2011-2012.
• Prescription proton-pump inhibitors (PPIs) increased from 3.9% to 7.8%.
• The 10 most commonly used drugs in 2011-2012 were simvastatin (a statin for high cholesterol), lisinopril (hypertension), levothyroxine (hypothyroid), metoprolol (another antihypertensive), metaformin (diabetic med), hydrochlorothiazide (diuretic), omeprazole (PPI), amiodipine (another antihypertensive), atorvastatin (another statin), and albuterol (asthma).

The author asks the critical question – Is a primary care physician (PCP) managing the patient’s multiple medications to ensure that each is warranted and that the combination is optimal?

My Take:
Are Americans taking too many medications? Yes. Is a PCP managing the patient’s meds? No, they may be pretending to too so, but there is no way to manage polypharmacy. The interactions between the various meds are so numerous and varied that it can not be managed.

I am constantly amazed that a patient can actually walk into my office taking 10 or more medications. I know that I could not function under that drug load, but their bodies slowly adapt over time. They’re alive, but not really living.

The Bottom Line:
If you look at the top nine medications, they all treat diseases stemming from metabolic syndrome – a preventable condition. I have a T-shirt that I wear frequently and it reads:

I take Metformin for the diabetes caused by the Hydrochlorothiazide I take for high blood pressure which I got from the Ambien I take for insomnia caused by the Xanax I take for the anxiety that I got from the Wellbutrin I take for chronic fatigue which I got from the Lipitor I take because I have high cholesterol because a healthy diet and exercise with regular chiropractic care and superior nutritional supplements are just too much trouble!