Taking Multiple Medications? Why a Regular Medication Review Matters

Taking several medications can make it harder to spot an interaction or recognize that a new symptom may be a side effect. A medication review can help patients and clinicians look at the full picture, especially when prescriptions come from different providers. The aim is to make treatment safer and more suitable over time, not simply to reduce the number of medications.

Jonathan Bledsoe, of Reading, Pennsylvania, learned that the hard way. For nearly three years, he took medication to stabilize his mood and another to manage cholesterol, along with other prescriptions. When his urine turned the color of brewed coffee, he contacted his doctors. They found that an interaction between his medications was beginning to harm his liver. After his medications were changed, his liver and kidney function returned to normal.

His experience points to a wider challenge. A study in JAMA Internal Medicine found that the share of Americans over 65 taking five or more medications nearly doubled between 2000 and 2020. More than one-third of older adults now take at least five medications each day. This pattern is known as polypharmacy.

Amanda Mixon, a hospitalist and associate professor of bioinformatics at Vanderbilt University, said she sees older patients taking an average of 16 medications, sometimes prescribed by several clinicians and filled at different pharmacies. Each medication may have a purpose, but the combination can raise the chance of interactions and side effects. As prescriptions accumulate, it can also become harder to tell which drug may be connected to a new problem.

When treatment adds another treatment

One way medication lists grow is through a prescribing cascade. A medicine causes a side effect, that side effect is treated with another medicine, and the added treatment can bring its own effects. The original prescription may still be appropriate; the concern is whether the full combination continues to make sense for that person.

Mixon offered the example of someone with heart failure who takes a water pill to reduce fluid buildup. More frequent urination may contribute to incontinence, which can then be treated with another medication. Reviewing the sequence can help a care team consider whether there are other ways to address the problem or whether a medicine’s benefits still outweigh its drawbacks.

Pharmacist DeLon Canterbury, chief executive of the consulting company GeriatRx, said clinicians are trained to diagnose and treat health problems, but may not always have a complete view of a patient’s prescriptions. Different health systems can keep separate records, and multiple prescribers may not know what others have prescribed. Patients shouldn’t assume that every medicine and supplement is being checked together automatically, he said.

What a medication review can cover

Deprescribing means intentionally reducing or stopping a medication when a clinician and patient determine that it is no longer needed or that its risks outweigh its benefits. The practice has gained momentum over the past decade, alongside rising use of multiple medications and concern about related harms. Research on how to taper medicines safely is newer and isn’t yet widely taught in medical schools, Canterbury said.

That makes a conversation with a primary care provider or specialist a useful starting point for anyone worried about a medication, particularly after a new symptom or unexpected side effect. The clinician can review why each medicine was started, what it is intended to do, whether it may interact with other drugs, and whether any change needs to happen gradually. Some medications can cause problems if stopped abruptly, so a review should lead to a plan made with the care team.

The goal is not to stop as many medicines as possible. A drug that remains helpful may still be the right choice, while another may need adjustment as a person’s health changes. Age can affect how the body processes medication, which may alter the likelihood of side effects such as constipation, diarrhea, falls, or memory problems. A clinician can weigh those concerns against the reason for treatment.

A medication list makes the discussion easier

Keep an up-to-date list of prescription medicines, over-the-counter products, vitamins, and supplements. Include the name and, if known, why you take each one and who prescribed it. Carry the list to appointments and share it with pharmacists, especially when seeing a new provider or filling a prescription at a different pharmacy.

A paper list can work as well as a tracking app or QR code bracelet. Pharmacist Jen Hammons, director of rural health advancement at the Appalachian College of Pharmacy in Virginia, recommends having a list available for people who can’t reliably recall every medication from memory. Update it when a clinician changes a prescription, and bring questions about possible side effects or interactions to the next medication review.

A review may take time, particularly when several clinicians are involved or a medication needs a gradual reduction. Still, an unexpected symptom is a reasonable reason to ask whether a medicine or combination could be contributing. A clear list and an open conversation give the care team a better chance to assess the whole regimen and decide what, if anything, should change.