By some estimates, more than 40 percent of U.S. seniors take five or more prescription drugs each day, a rate that has tripled in the past 20 years. I’m now beginning to understand how that accumulation of various pills, known as polypharmacy, could happen to someone.
After much discussion during my annual wellness visit last week, my doctor increased the dosage of one of my two blood pressure meds and prescribed a new statin for cholesterol control as well as a topical cream to ward off skin cancer eruptions. She also suggested that I begin taking a magnesium supplement and a regular dose of CoQ10 to try to ward off recurring episodes of peripheral neuropathy.
All this for a guy who three years ago rarely even took an aspirin.
But aging often produces surprising ailments, and various factors can contribute to an overfilled medicine cabinet. As Cynthia Nwaubani, PharmD, explains in a recent PharmD Live blog post, seniors tend to develop multiple chronic conditions that providers, following clinical guidelines, treat with multiple types of medications. Those drugs may be prescribed by more than one practitioner, who may or may not be aware of current prescriptions or their potential interactions. Meanwhile, patients often self-medicate with over-the-counter supplements without consulting their physician.
These factors can combine to increase the risk of harmful drug interactions, leading to conditions ranging from vertigo and frailty to internal bleeding and low blood-sugar levels. And those side effects are often treated with — you guessed it — more drugs.
Writing in The New York Times, Knvul Sheikh describes a “prescription cascade” scenario in which a patient takes an over-the-counter medication that spikes their blood pressure, which their physician treats with a calcium channel blocker, which leads to swollen ankles, which requires a diuretic. “So you just end up chasing side effects of one medication after the next,” notes Nina Blachman, MD, a geriatrician at the NYU Grossman School of Medicine.
And, as I’m beginning to learn, that can become an exercise in pharmaceutical juggling. After a hypertensive crisis sent me to the ER in 2023, I left with a prescription for an ACE inhibitor. My doctor soon afterward added a calcium channel blocker and, a few months later, a statin. When I began to experience frequent, intense episodes of neuropathy — numbness and tingling all down the left side of my body — I suspected the ACE inhibitor was to blame. So, I convinced my doctor to swap that out in favor of an angiotensin receptor blocker.
But the episodes, though less frequent and intense, continued. So we agreed to drop the particular statin I was using, which I learned had developed a reputation for causing these symptoms. That seemed to help, though it didn’t completely alleviate the neuropathy. And we both agreed that I couldn’t expect to control my troubling cholesterol levels without some pharmaceutical intervention, so she prescribed a different statin and advised me to start with a low dose and build up to the optimal level over a two-month period.
She also suspected that the arthritis in my neck may be contributing to the neuropathic annoyances and suggested a regular dose of magnesium may help quiet what appears to be a disturbance of my nervous system. The CoQ10? That might offset the side effects of the statin.
My daily pill-taking regimen now includes two blood pressure drugs, a statin, magnesium, CoQ10, saw palmetto for my prostate, and an AREDS 2 supplement for my vision. Oh, and a spoonful of fish oil.
And that doesn’t include the topical cream that sits in the medicine cabinet awaiting the next appearance of basal cell carcinoma. It appears to be a welcome alternative to the flesh carving I suffered during my first dermatological adventure nearly two years ago. I may even ask my doctor about recent research suggesting that a daily regimen of vitamin B3 may keep future lesions at bay. What’s one more pill, right?
It’s a humbling ritual for a septuagenarian who not that long ago prided himself on enjoying a drug-free, healthy lifestyle.
At some point, however, another question arises: How do I wean myself from some of these meds? Kuldip Patel, PharmD, senior associate chief pharmacy officer at Duke University Hospital, tells the Times that he and his team review the prescriptions patients are taking upon each hospital admittance or discharge. That doesn’t always happen at other facilities, he adds, but patients can also ask their doctors to evaluate their meds at least once a year.
And don’t hesitate to ask your provider how long you may need to take a certain drug, says Barbara Farrell, PharmD, a research scientist at the Bruyere Research Institute in Ottawa. Together, you may be able to develop a plan that allows you to gradually taper off the medication as the symptoms diminish.
“These are questions people should be asking even in their teens and 20s when they’re being started on some of these medications,” Farrell advises. “Then hopefully someday we’ll be able to prevent people from getting to the point where they’re taking 25 medications all together.”
I’ll be checking back in with my doctor in a couple of months, when we can evaluate the various effects of my expanded drug regimen. Perhaps at that time, we’ll be able to shift some dosages or eliminate some medications altogether. That is, unless some other ailment arises in the interim.
