A guide to polypharmacy: what it is, why it matters, and what you can do about it

Important Note Before We Begin: This article is for educational purposes only. Please do not change, stop, or adjust any of your medications without talking to your doctor or pharmacist first. Some medications can be dangerous or even life-threatening if stopped suddenly. Your healthcare team knows your situation best. Soon Medome.ai will.

Meet the Pill Pile

Picture your grandparent’s bathroom counter. Maybe there’s a little tray or, let’s be honest, an entire zip-lock bag full of different colored pills. One for blood pressure. One for cholesterol. One for sleep. One for the heartburn that the blood pressure pill caused. One for the ankle swelling that the heartburn pill caused. And so on.

This is called polypharmacy, a fancy Greek word meaning “many drugs,” and it affects millions of Americans every single day. Officially, it means taking five or more medications regularly. Unofficially, it means things are about to get complicated.

The Numbers Are Kind of Alarming

Let’s start with some facts that will make you put down your pill organizer for a second:

• About 40% of older adults in the U.S. take five or more prescription medications daily. Roughly 20% take ten or more. Ten.

• Adverse drug reactions, meaning bad things that happen because of medications, account for 1 in 10 emergency room visits.

• Patients taking seven or more medications have approximately an 80% chance of experiencing an adverse drug reaction. That’s not a typo.

• Warfarin (a blood thinner) and insulin (for diabetes) alone cause hospitalizations at rates 48 times higher than the medications that most “watch lists” warn about. The medications we think are dangerous often aren’t the ones causing the most trouble.

• Falls, often caused by medications, are one of the leading causes of injury in older adults, accounting for nearly 20% of drug-related hospitalizations.

These aren’t scare statistics. They’re a call to pay attention.

How Does This Even Happen?

Great question. Nobody wakes up one day and says, “I’d like to take twelve pills with breakfast.” It happens gradually, and here’s the sneaky way it usually goes:

Step 1: You get diagnosed with high blood pressure. You get a pill.

Step 2: The pill causes ankle swelling. Your doctor prescribes a water pill (diuretic) for the swelling.

Step 3: The water pill makes your potassium drop. You get a potassium supplement.

Step 4: The combination of medications makes you dizzy. You fall. You hurt your knee. You get a painkiller.

Step 5: The painkiller causes acid reflux. You get an antacid.

Before you know it, you’re taking five medications and four of them exist to manage side effects of the first one. This is called a prescribing or drug cascade, and it’s about as fun as it sounds.

Other reasons polypharmacy happens include multiple doctors who don’t always talk to each other, guidelines that tell doctors to add medications for specific conditions without considering the full picture, automatic refills that keep rolling without anyone checking if you still need the medication, and simply getting older. Older bodies process drugs differently, so the same dose that was fine at 50 can cause problems at 75.

The Usual Suspects

Certain types of medications show up in polypharmacy horror stories more than others. Think of these as the high-drama characters in the pill soap opera:

Benzodiazepines (like Valium or Xanax): Great for short-term anxiety or sleep, but long-term use increases fall risk and memory problems, and they’re notoriously hard to stop because your body gets used to them.

Proton Pump Inhibitors (like omeprazole, the purple pill): Excellent for severe acid problems, but many people end up on these for years longer than necessary. Long-term use is linked to bone loss, kidney issues, and infections.

Anticholinergics: This is a sneaky category that includes some allergy medications, bladder pills, certain antidepressants, and even some stomach medications. Each one alone seems harmless. But stack them up and you can get memory problems, constipation, blurry vision, and confusion, especially in older adults.

NSAIDs (like ibuprofen): Fine for occasional headaches, but regular use alongside blood pressure medication or blood thinners can be a recipe for kidney damage or dangerous bleeding.

Opioids: Powerful pain relievers that, when combined with other sedating medications, can slow breathing to dangerous levels.

The Anticholinergic Burden: The Villain You Never Heard Of

Here’s something genuinely fascinating and a little scary. Many completely normal, commonly prescribed drugs have a sneaky side effect: they block a chemical in your brain called acetylcholine. One such drug? Probably no big deal. But take three or four of them together, even if each one is considered “low risk,” and suddenly you’ve got what doctors call anticholinergic burden.

The effects include confusion, memory problems, constipation, dry mouth, and falls. According to research, high anticholinergic burden may be linked to more than double the risk of developing dementia over time.

The wild part is that most patients and sometimes even their doctors don’t realize that their allergy pill, their bladder medication, and their antidepressant are all pulling in the same problematic direction.

So What Can Actually Be Done?

Here’s the good news: this problem is recognized, it’s being studied, and there are real solutions. The process of safely reducing unnecessary medications even has a name, deprescribing, which sounds like something your doctor does when going backwards through a prescription pad.

Tools Doctors Use

Physicians and pharmacists use several checklists and tools to spot medication problems:

1. Beers Criteria: A list maintained by the American Geriatrics Society of medications that are often risky for older adults. Think of it as the “Are You Sure About This?” list.

What is the Beers Criteria?

The American Geriatrics Society Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults is a list of medication guidelines that help healthcare providers safely prescribe medications for adults over age 65.

Studies show that over 90% of adults over age 65 take at least one prescription medication, while more than 66% of the same group take more than three prescriptions a month. The Beers Criteria is a list of potentially harmful medications or medications with side effects that outweigh the benefit of taking the medication.

Beers Criteria is also known as the Beers list.

What are the five Beers criteria?

The American Geriatrics Society uses specific criteria to list potentially inappropriate medications for adults over age 65. The five sections of the Beers Criteria are:

1. Medications to avoid if you’re over 65 years old and not in a hospice or a palliative care setting.

2. Medications to avoid among people with certain health conditions.

3. Medications to avoid that cause drug interactions when combined with other medications.

4. Medications to avoid due to harmful side effects that outweigh the benefits.

5. Medications to use at limited doses or avoided due to their effects on kidney function (renal impairment).

What medications are on the Beers Criteria list?

There are close to 100 medications or medication classes on the Beers Criteria list. The following list isn’t comprehensive, but it gives an example of a drug in each category and the reason why it’s harmful:

• Analgesics (meperidine): Neurotoxicity, delirium.

• Antibiotics (ciprofloxacin with warfarin): Increased bleeding.

• Antiseizure medications (carbamazepine): Syndrome of inappropriate antidiuretic hormone secretion (SIADH).

• Antihistamines (brompheniramine): Confusion, cognitive impairment, delirium.

• Antihypertensives (alpha-blockers): Hypotension.

• Antiplatelets or anticoagulants (edoxaban): Renal impairment.

• Antipsychotics (any): Stroke, cognitive decline, delirium.

• Anxiolytics (benzodiazepines): Impaired metabolism, cognitive impairment, unsteady gait.

• Cardiac medications (disopyramide): Heart failure.

• Central nervous system agents (dimenhydrinate): Confusion, cognitive impairment, delirium.

• Diabetes medications (chlorpropamide): Hypoglycemia.

• Gastrointestinal medications (H2-blocker for delirium): Worsening delirium.

• Hormones (estrogen): Breast cancer, endometrial cancer.

• Hypnotics (barbiturates): Dependence, overdose.

• Musculoskeletal agents (muscle relaxers): Confusion, dry mouth, constipation.

• NSAIDs [aspirin (more than 325 mg/day)]: Ulcer, gastrointestinal bleeding or perforation.

• Respiratory medications (atropine): Confusion, cognitive impairment, delirium.

• Urinary medications (desmopressin): Low sodium in blood (hyponatremia).

• Vasodilators (ergoloid mesylates): Lack of intended results.

How often is the Beers Criteria updated?

The American Geriatrics Society reviews and publishes the Beers Criteria list every three years.

2. STOPP/START Criteria: STOPP finds medications that should probably be stopped; START finds medications that should probably be added but aren’t. In one study, 78.7% of older adults with polypharmacy were found to be missing at least one medication they actually needed.

3. Medication Appropriateness Index: A deeper evaluation of whether each drug is the right one, at the right dose, for the right reason.

The Deprescribing Process

When it’s time to reduce medications, physicians typically work like this:

1. List every single medication (including supplements and over-the-counter drugs)

2. Ask: does this person still need this?

3. Look for dangerous interactions

4. Rank which ones are lowest priority

5. Taper or stop carefully, one at a time, while monitoring for problems

The one-at-a-time rule matters because if you stop three medications at once and something goes wrong, you have no idea which one caused it.

Some Medications Need a Slow Goodbye

You cannot just stop certain medications cold turkey. This is critical to understand:

Benzodiazepines: Stopping suddenly can cause seizures. Tapers can take months.

Opioids: Sudden stopping causes painful withdrawal. Doctors typically reduce the dose by 5 to 10% every few weeks.

Antidepressants: Stopping quickly can cause “discontinuation syndrome,” including dizziness, nausea, and those delightful “brain zap” sensations people describe.

Beta-blockers (heart medications): Stopping abruptly can trigger dangerous heart problems.

Steroids: Long-term steroid users may have suppressed adrenal glands, and stopping suddenly can cause a serious hormonal crisis.

Again: never stop these medications without guidance from your doctor.

What You Can Actually Do (Without Playing Doctor)

While we’re being very clear that you should not self-prescribe or self-deprescribe, there are absolutely things you can do to be a better advocate for yourself or a family member:

Use Medome.ai: Put every single medication including prescription drugs, over-the-counter products, vitamins, and herbal supplements into Medome and let Medome run a safety analysis.

The Bag Test: Put every single medication including prescription drugs, over-the-counter products, vitamins, and herbal supplements into a bag and bring it to your next doctor’s appointment. This is called a “brown bag review” and it’s more helpful than it sounds.

Ask “Why?”: For each medication, it’s completely reasonable to ask your doctor: “Why am I taking this? Do I still need it? What happens if I stop?”

Mention new symptoms: Many people experience side effects and assume it’s just aging or a new problem. Always mention new symptoms to your doctor because it might actually be a medication causing them.

Request a medication review: You can specifically ask your doctor or pharmacist to review your full medication list for interactions or things that might be outdated. Pharmacists in particular are excellent at this and wildly underutilized.

Keep one updated list: One accurate, current medication list that you bring to every appointment with every doctor can prevent enormous problems when providers aren’t communicating well with each other. Medome is perfect for this.

The Silver Lining

Here’s something encouraging: 88% of older adults say they would be willing to stop a medication if their doctor said it was safe to do so. That means patients are ready for this conversation and are simply waiting for someone to start it.

Studies show that when deprescribing is done thoughtfully, it doesn’t lead to more hospital visits or worse health. In many cases, people feel better after shedding medications they didn’t need anymore, reporting clearer thinking, fewer falls, better digestion, and more energy.

One clinical trial found that a well-designed medication reduction program didn’t increase emergency visits or deaths. People just had fewer pills to take and felt fine. Sometimes better.

The Bottom Line

Medications save lives. There’s no question about that. But more is not always better, older bodies are not the same as younger ones, and a pill prescribed in 2015 may not be the right pill for 2025.

Polypharmacy isn’t a personal failure or a sign that your doctors did something wrong. It’s a natural result of treating multiple health conditions over many years. But it does deserve regular attention, the same way you’d reassess a budget or a closet full of clothes that no longer fit.

Use Medome. Talk to your doctor. Ask the questions. Bring the bag. And remember that sometimes the healthiest thing you can do is stop taking something.

Just not without asking first.

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Sources for this article are drawn from peer-reviewed literature including the AGS Beers Criteria (2023), STOPP/START Criteria, CDC prescribing guidelines, and studies published in JAMA, JAMA Internal Medicine, the New England Journal of Medicine, and the American Journal of Gastroenterology, among others.

What Is Hospice Care? Hospice care is specialized care that provides physical comfort and emotional, social and spiritual support for people nearing the end of life.