March 2026

Volume 12 - Issue 01

Practical tips for management of polypharmacy

Polypharmacy, literally meaning “many medications,” is commonly defined as the regular use of five or more medicines, including prescription, over-the-counter, traditional, or complementary products.

While sometimes necessary, polypharmacy can increase the risk of adverse drug reactions, drug–drug or drug–disease interactions, falls, functional decline, and poor adherence—especially among older adults and those with multiple chronic conditions.

The following tips outline practical approaches to managing polypharmacy and reducing its risks:

• Verify actual medication use: Never assume that patients are taking medications exactly as prescribed.
• Clarify prescription purpose: Ensure each medication has a clearly documented indication or medical condition for which it is intended.
• Prioritize substitution over addition: Whenever appropriate, substitute medications rather than adding new agents to existing regimens.
• Simplify medication regimens: Aim to limit dosing to once or twice daily where possible. Minimize overall “pill burden” while maintaining effective therapy.
• Provide clear instructions: Ensure patients receive written guidance, including detailed dosing schedules.
• Recognize and mitigate risks: Be aware of potential side effects, drug–drug interactions, and drug–disease interactions associated with prescribed medications.
• Collaborate with clinical pharmacists: Engage in discussions with pharmacy colleagues in both community and hospital settings, particularly for complex or long-term regimens. They can assist with medication safety, identify potential interactions, recommend suitable formulations, and support patient understanding.
• Monitor, review, and adjust regularly: Medication review is an ongoing process that requires a multidisciplinary approach and continuous patient monitoring.

Medication review tools

To help healthcare providers identify opportunities to improve medication management and optimize treatment plans, medication review tools are often used alongside clinical judgment and patient input to support patient-centered care.The choice of tool depends on the population being assessed and the goals of the review. Some commonly used tools are listed below (see Figure 3)

Examples of medication review tools for screening polypharmacy:

• Beers Criteria (AGS Beers List)
• STOPP/START Criteria
• Medication Appropriateness Index (MAI)
• NOR-FRAIL Tool (Fatigue, Resistance, Aerobic capacity, Illnesses, and Loss of weight)
• MedStopper Tool
• Anticholinergic Burden (ACB) Calculator

Summary

Practical management of polypharmacy relies on regular medication review, effective use of clinical tools, and close collaboration among healthcare professionals. With this approach, polypharmacy can be transformed from a risk into an opportunity for safer, more individualized patient care.