For nearly three years, Jonathan Bledsoe of Reading, Pennsylvania, took a prescription medication to stabilize his mood and another to control his cholesterol, along with several other medications.
“You wouldn’t think that you have to advocate for yourself and look out for yourself when it comes to managing your medications,” the Navy veteran said. “But when you wake up one morning and your urine comes out the color of freshly brewed coffee, there’s a problem.”
Bledsoe consulted all of his doctors about these troubling symptoms and discovered that the interaction between his medications was starting to damage his liver. After changing medications, his liver and kidney functions returned to normal.
Adverse drug interactions are becoming a growing health problem as more people take multiple drugs, said Amanda Mixon, a hospitalist and associate professor of bioinformatics at Vanderbilt University.
The percentage of Americans over age 65 taking five or more medications, a practice known as polypharmacy, nearly doubled between 2000 and 2020, according to a study published in JAMA Internal Medicine. Currently, more than a third of older adults take five or more medications a day.
Mixon said he sees older patients who take an average of 16 medications, often prescribed by different professionals and obtained at several pharmacies.
“As more and more medications are accumulated, the possibility of them interacting with each other and causing harmful effects increases,” Mixon said. “As these medications are added progressively, their effects can accumulate over time and people end up experiencing more side effects.”
HealthQ’s advice:
If you take medications and supplements, keep an up-to-date list of everything you consume and always carry it with you.
If you’re worried about the medications you take, here’s what you need to know:
- There is no such thing as a “unicorn pharmacist.”
Sometimes a medication meant to treat one problem ends up causing many others. This is known as a “prescription cascade”: a medication prescribed to treat an initial symptom causes a side effect, which in turn requires another treatment. Over time, combining medications can cause new problems that require even more remedies.
For example, Mixon explained, patients with heart failure take diuretics to reduce fluid retention. As a result, the constant need to urinate can cause incontinence, which is treated with another medication.
“We do an extraordinary job treating diseases. We are very good at diagnosing, and medications play an incredible role in increasing our longevity,” said pharmacist DeLon Canterbury.
Canterbury is CEO of GeriatRx, a North Carolina-based consulting company that specializes in helping patients stop taking unnecessary medications. “The intention of our health professionals is not to overtreat. It is simply what we have been taught to do.”
When multiple prescribers are involved, they may not know all the drugs the patient takes, he explained, especially if they work in different health systems that maintain separate medical records.
“Don’t assume that someone is checking all this stuff without you knowing. There’s no magic unicorn pharmacist making sure everything is safe. Yes, even at your neighborhood pharmacy,” Canterbury said. “So, if you notice that something is not right, make sure to defend your own interests.”
- A shift toward reducing prescriptions
“Deprescribing,” the process of deliberately tapering or stopping medications, has gained more momentum over the past decade, while polypharmacy and the health risks associated with it have increased.
Research on how to safely taper medications is more recent and is not yet widely taught in medical schools, Canterbury said.
Patients concerned about taking multiple medications — especially those experiencing a new symptom or unexpected side effect — should start a conversation about deprescribing with their specialists or primary care doctors, he explained.
“I promise you they don’t bite,” he said. “Because you will be surprised that the more you raise the possibility of stopping a medication, the more willing professionals will be to have that conversation and help you stop it if you don’t need it.”
The goal is not to stop taking as many medications as possible, Canterbury clarified, but to ensure patient safety. With age, the body metabolizes medications differently, he explained, which increases the likelihood of harmful side effects, such as constipation, diarrhea, falls and memory loss.
- Keep a list of your medications
Many pharmacists and doctors agree on the importance of keeping an up-to-date list of medications you take, including vitamins and supplements. Although there are bracelets with QR codes and applications to keep track of medications, sometimes the simplest strategy is to resort to a sheet of paper.
“Everyone needs to carry a medication list in their pocket,” said pharmacist Jen Hammons, director of rural health development at Appalachian College of Pharmacy in Virginia. “If you can’t remember them all, you need to have a list.”
- People and public policies
Health and Human Services Secretary Robert F. Kennedy Jr. has advocated reducing the use of psychiatric medications among Americans, arguing that they are overprescribed, a stance that has polarized the medical community.
This year, the Centers for Medicare & Medicaid Services (CMS) released new guidelines that clarify how doctors and pharmacists can get paid for their work reviewing patients’ medications and helping them taper them off when appropriate.
Doctors had previously expressed doubts about whether they could receive remuneration for deprescribing, a process that can be time-consuming.
Nashville Public Radio’s Katherine Ruppelt and Emily Siner contributed to this article.
HealthQ is a health series from journalists Cara Anthony and Blake Farmer, offering accessible guides to understanding a difficult-to-navigate healthcare system. It is a collaboration between Nashville Public Radio and .
