Taking many medicines at once has a name, polypharmacy, and it is more common from age 65 on: people age 65 and older tend to take more medicines than those in any other age group, often because they have several health problems at the same time. When nine of yours were written by four different doctors over the years, and a tenth has just arrived, each doctor could check a prescription only against the medicines they knew you took. Taking many medicines can also raise the risk of side effects and other unintended problems.
Why each prescription needs checking against all the others
Medicines can change how one another work, so a prescription that was sound on its own can act differently beside the other nine. A drug interaction is a change in the way a drug acts in the body when it is taken with certain other drugs, foods or supplements, or while you have certain medical conditions. It could make a drug more or less effective, cause side effects, or change the way one or both drugs work. Examples include:
- two drugs, such as aspirin and blood thinners
- a drug and a food, such as statins and grapefruit
- a drug and a supplement, such as ginkgo and blood thinners
- a drug and a medical condition, such as aspirin and peptic ulcers
When two medicines react with each other, one can work less well, or one can become stronger than it should be. If you take a prescription blood thinner such as warfarin, do not take aspirin unless your doctor tells you to. Aspirin is sold over the counter, without a prescription, so tell your doctor if you take it, along with any other medicine you buy without a prescription.
As you get older, body changes can affect the way medicines are absorbed and used:
- changes in the digestive system can affect how fast medicines enter the bloodstream
- changes in body weight can influence the amount of medicine you need to take and how long it stays in your body
- the circulation may slow down, which can affect how fast drugs get to the liver and kidneys
- the liver and kidneys may work more slowly, affecting the way a drug breaks down and is removed from the body
Because of these changes, the risk of drug interactions is also bigger in older adults. If your weight is changing, through weight care or for any other reason, tell the doctor who reviews your list.
Who reviews the whole list when four different doctors wrote it
Ask your primary care doctor to review the whole list, including what the other three doctors prescribed, and to tell you how your medicine schedule needs to change when you see more than one doctor. If you have no primary care doctor, ask your pharmacist for an appointment to check everything you take.
| Who | What they need from you | What to ask them |
|---|---|---|
| Your primary care doctor | The whole list, and the specialist doctors you see on a regular basis | For a complete medicine schedule in writing, with directions on exactly when and how to take each medicine |
| Each doctor who prescribes for you | The whole list, with any new prescription drugs, over-the-counter medicines and supplements since your last visit | Whether you still need to be on all your medications |
| Your pharmacist | Every drug, over-the-counter medicine, vitamin and supplement you take | Whether there is a patient profile you can fill out |
If you are concerned that you might be taking too many, ask your primary care doctor whether there are any you could safely reduce or stop. Safely reducing or stopping medicines that may be inappropriate or unnecessary is called deprescribing. Ask the doctor who prescribed each medicine you take regularly to check how well it is working, and talk with that doctor before you stop any of them.
Many pharmacists keep track of medicines on their computer, and if you buy your medicines at one store and tell the pharmacist everything you take, the pharmacist can help make sure they do not interact harmfully. Try to have all your prescriptions filled at one pharmacy, so your records are in one place and the pharmacist can be alerted if a new drug might cause a problem with something else you take. If you are unable to use just one, share your list with the pharmacist at each location when you drop off a prescription. If you book a pharmacist appointment to check everything, bring all your medicines and vitamins to it in a bag, antacids, pain relievers and laxatives included.
What to write on your medicine list
Write down everything you take, including what you bought without a prescription. Your health care team needs to hear about all the medicines, vitamins, herbals and dietary supplements you take, and that includes:
- prescription medicines
- medicines you can buy without a prescription, such as aspirin, diet pills, antacids, laxatives, allergy medicine and cough medicine
- vitamins, including multivitamins
- dietary or herbal supplements, such as St. John's wort or ginkgo biloba
Eye drops and topical medicines such as creams and ointments count too. Mention everything, even the ones you use infrequently.
For each item, write the name, the amount you take and the time or times you take it. For a prescription, add the doctor who prescribed it and the reason it was prescribed, so the doctor reviewing the list can see who to ask about each medicine and what each one is for. If you are unsure why you take one, ask its prescriber what the medicine is and why you are taking it, and write the answer on your list. When a doctor writes you a new prescription, ask them to write down on it why you need the medicine. Tell your health care team, too, about any allergies, including medicine-related allergies, and any problems you have had when taking a medicine.
Show the list to all your health care providers, physical therapists and dentists included, and keep one copy in a safe place at home and one in your wallet or purse. Add new medicines when you start taking something new, so write the new one on it now, and give a copy to a family member or friend.
For the new medicine, ask its prescriber whether this new prescription means you should stop taking other medicines, and whether you need any tests while you are on it. A close friend or relative can come to the appointment with you to help you understand and remember the answers, and can write down what the doctor says about your medicines. If the new medicine is a weekly weight medicine, show its prescriber the whole list as well (see A weekly weight medicine can change how some of your other tablets work).
Which changes since the new medicine started cannot wait for the review
Difficulty breathing, or any other symptom of severe asthma or of anaphylaxis, a severe, acute allergic reaction, cannot wait for the review: it is an emergency, so go to an emergency room or call 911. Symptoms of anaphylaxis include:
- abdominal pain or cramping
- confusion
- diarrhea
- difficulty breathing with wheezing or a hoarse voice
- dizziness
- fainting or lightheadedness
- hives over different parts of the body
- nausea or vomiting
- a rapid pulse
- feeling your heart beat, called palpitations
Many people confuse an unpleasant but not serious side effect of a medicine, such as nausea, with a drug allergy. Phone the new medicine's prescriber's office right away if you have an unwanted side effect, any other problem with your medicines, or a worry that one might be doing more harm than good. Contact that office too about a minor skin rash or hives, which is how most drug allergies show up, and they may appear right away or hours after the medicine, so a gap of hours does not rule the medicine out.
For uncomfortable side effects, talk with that doctor before you stop taking the medicine, and write them down so you can report them accurately. The doctor may be able to prescribe a different medicine or help you deal with the side effects in other ways.
If you have noticed a change in yourself over the past year, such as feeling slower, and put it down to age, mention it to your primary care doctor's office when you book the review. New symptoms or mood changes may not be a result of getting older, and could come from a medicine or from another factor, such as a change in diet or routine.
A weight medicine that a physician prescribed for you through NicoCares belongs on the list too. Your NicoCares care team answers you in Spruce, an app for secure messages, and a message there has no deadline for a reply, so for a change after starting that medicine that needs a doctor right away but is not an emergency, phone your primary care doctor's office. Tell the care team in Spruce promptly as well, as you would about any side effect, new medication or change in your health.
Where to keep the bottles once the list is written
Keep the bottles off the kitchen counter, together in one dry, cool place: the kitchen and the bathroom are bad places to store medicine because of heat and moisture. A medicine that has to stay cold is the exception, so ask your pharmacist about special instructions on where to store each one, such as whether it should be kept in the refrigerator, and make sure a medicine you keep there does not freeze. Keep all medicines out of the sight and reach of children, including on the days young children visit (see Move the weight medicine off the fridge door if young children visit).
If child-proof caps are hard for you to take off and no young children live in or visit your home, ask your pharmacist to put your prescription medicines in easy-to-open containers. Bottles without safety caps need extra care about where you store them, and if a label is hard to read, ask the pharmacist to use larger type.
When the review stops a medicine, throw it away, along with any medicine that has expired, and ask your doctor or pharmacist how to throw away that specific medication.
