Too Many Pills? A Guide to Understanding Polypharmacy

Lesson Outline

Taking several medications, what healthcare providers call polypharmacy, is common, and often necessary. But as we age, our bodies change, and so can the way medications affect us.

The good news? You don't need to navigate this alone. There are steps you can take to better understand your medications, ask the right questions, and feel more confident in your care.

Meet Frieda, who, like many older adults, takes several medications, and the list has grown over time. Find out what steps she takes to better understand her medications.

 15 minutes

Start Lesson

⏱ 2 min read

What is polypharmacy?

Polypharmacy is defined as taking five or more medications at the same time. It’s very common among older adults:

• 60% of Canadians over 65 take at least five prescription medications.¹
• 25% take ten or more.²

Why does this happen?

• Many older adults live with multiple health conditions, such as diabetes, hypertension, and arthritis.
• Evolving medical guidelines often recommend medications as first-line treatments.
• Seeing several healthcare providers can lead to overlapping prescriptions.
• Sometimes medications are added to manage side effects caused by other drugs.

While taking multiple medications is often necessary, it can increase the risk of side effects, drug interactions, and even hospitalizations.

Why aging matters

As we age, our bodies process medications differently. Two key concepts help explain this:

• Pharmacokinetics: How the body absorbs, distributes, metabolizes, and eliminates medications. Aging can slow absorption, change distribution, and reduce liver and kidney function, making it harder to clear drugs from the body.
• Pharmacodynamics: How medications affect the body. Aging can change sensitivity to certain drugs, increasing the risk of side effects.

These changes mean that medications prescribed years ago may act differently today.

Risks of taking multiple medications

Polypharmacy can lead to:

• Confusion and falls
• Adverse drug reactions
• Drug interactions
• Hospitalizations
• Financial burden

About 1 in 10 hospital admissions in older adults are related to adverse drug effects.¹

Common drug interactions

Medications can interact with each other, with food, and even with supplements. Here are a few examples of such interactions:

• Drug-drug: Aspirin and warfarin, when taken together, increase the risk of bleeding.
• Drug-food: Grapefruit juice can make cholesterol-lowering drugs stronger.
• Drug-supplement: St. John’s Wort, sometimes used to treat mild depression, can reduce the effectiveness of some medications.

What can you do?

A medication review with your doctor, pharmacist, or nurse practitioner is the best way to ensure your medications are still right for you. To prepare:

• Bring an updated list of all medications, including vitamins and supplements.
• Write down the reasons why you take each medication.
• Consider bringing a family member or friend to listen and take notes.

To help guide your conversation, Canada’s Drug Agency worked with patients, caregivers, and healthcare experts to create these five key questions to ask¹:

1. What is the purpose of each of my medications?
2. Could I be experiencing any side effects or drug interactions?
3. Could lifestyle changes also improve my well-being?
4. Are all my medications needed?
5. What other information should I know about my medications?

Deprescribing

Sometimes, a medication review reveals that certain drugs may no longer be needed, or could even be causing more harm than good. In these cases, your healthcare provider might suggest a process called deprescribing. Deprescribing is a safe, supervised process to reduce or stop medications gradually to avoid withdrawal symptoms or flare-ups. Your health goals and personal preferences should always be part of the decision. Keep in mind that 'deprescribing is part of good prescribing '.³

Learn more

Want to dive deeper? Take our 15-minute interactive lesson.

Sign up for our 5-week micro-learning series.

Take survey

Tell us what you think of this content by answering a few questions. Your participation will help us improve this resource. Take survey.