Taking too many medicines? How to raise it with your doctor

When it is worth asking for a medication review, how to prepare for the appointment and what deprescribing is, so you and your doctor can decide together.

If you think you take too many medicines, ask your doctor for a specific appointment to review your treatment, bring all your medicines (including those you buy without a prescription and supplements) and ask whether you still need each one. It is a reasonable request that many doctors welcome.

Over the years, treatment builds up: one doctor adds something, another specialist something else, and hardly anyone reviews the whole picture. We explain when it is worth asking for that review and how to raise it so it is useful.

When is someone considered to be taking "too many" medicines?

Health professionals usually talk about polypharmacy when someone takes five or more medicines on an ongoing basis; the Castilla-La Mancha pharmacotherapy bulletin defines it this way for treatments lasting at least six months, by any route. But the number alone does not tell you whether some medicines are unnecessary.

What matters is whether each one still has a clear reason, whether it works and whether its benefits outweigh its risks. You may take eight medicines and need all of them, or take four and find that one no longer makes sense. So the useful question is not "are they too many?" but "do I still need each one?". The Castilla y León regional government estimates, using Ministry of Health data, that polypharmacy affects around 10% of the population.

Which signs suggest it is worth asking for a review?

It is worth asking for a medication review when your treatment has grown over time, when several doctors prescribe for you or when you notice effects you did not have before. You do not need to feel unwell to ask: it is a reasonable and common request.

• You take medicines prescribed years ago and no longer know what they are for.
• Several specialists treat you and each has added something.
• After starting a medicine a new symptom appeared and you were prescribed another medicine for it. This is called a prescribing cascade: a side effect is mistaken for a new condition.
• You feel tired, dizzy, forgetful or have stomach problems with no clear cause. We cover this in I take lots of tablets and feel tired.
• You find it hard to keep to the schedule or often miss doses.
• You have come out of hospital with new medication and do not know whether it replaces what you took before.

How do I prepare for the appointment?

Arrive with all the information and your questions written down. The most thorough way is to bring a bag with all the medicines you take, including those you buy without a prescription, vitamins, supplements and herbal remedies, as MedlinePlus recommends.

If your GP is short of time, book a specific appointment to review your medication or start with the two or three questions that worry you most. There is a full guide in how to prepare for an appointment to review your medicines, and it helps to bring your personal medication list. Your pharmacist can also go through the list with you before the appointment.

What is deprescribing and what can I expect?

Deprescribing is a planned, supervised and individualised process to reduce the dose of, or stop, medicines that may be inappropriate, unnecessary or harmful, according to the definition used by the Castilla y León regional government. It is not simply "taking tablets away": it means reviewing your whole treatment with you.

The SESCAM bulletin recommends making changes gradually, with close follow-up at first, involving the person in the decisions and making clear that no change is irreversible. Some medicines should not be stopped suddenly, which is why it is so important that any change is decided and monitored by your doctor.

• Your doctor may stop a medicine, lower a dose or switch one for something simpler.
• They may decide to keep everything, and you will leave knowing what each medicine is for.
• As MedlinePlus reminds us, do not stop taking any medicine unless your doctor tells you to.

A practical example: Elena and her nine medicines

Take the case of Elena, 64, self-employed, with high blood pressure, type 2 diabetes, osteoarthritis and acid reflux. Between her GP, her endocrinologist and her orthopaedic specialist, she has ended up taking nine medicines, and lately she has been feeling dizzy in the mornings.

1. She asks her GP for a specific appointment to review her medication.
2. She puts all her boxes in a bag, including the painkiller she buys without a prescription and a magnesium supplement.
3. She writes down three questions: whether the dizziness could be caused by her medication, whether she still needs the stomach protector she started after an operation, and whether her schedule can be simplified.
4. Her GP checks her blood pressure, decides to adjust one medicine gradually and books a follow-up to see how she gets on.
5. Elena updates her medication list with the changes and takes it to her pharmacy.

Elena leaves the appointment understanding her treatment and with a clear plan, without having stopped anything on her own.

How can IMA Health help after your medication has been reviewed?

When your doctor changes your prescription, what matters is that the changes are applied correctly from day one. At IMA Health we coordinate with a specialised pharmacy that prepares your medication by day and time of each dose, incorporating any changes to your treatment, we deliver it to your home and we provide personalised follow-up.

You can see how it works in the IMA Health service.

Sources

• SESCAM: Castilla-La Mancha pharmacotherapy bulletin, "Deprescribing in people taking multiple medicines" (2015, in Spanish)
• Castilla y León Regional Government (Sacyl): Deprescribing (in Spanish)
• MedlinePlus: Taking multiple medicines safely
• WHO: Medication safety in polypharmacy, technical report (2019)

This article is for information only and does not replace advice from your doctor or pharmacist.