Answers

What is polypharmacy, and when does it matter?

A medicine list can grow with each doctor who adds to it, and no one doctor may see all of it. Polypharmacy is the clinical name for a long list, and on its own the word doesn't say whether anything is wrong.

Arun Verma, co-founder of Triangle · 2026-10-19

This is not clinical evidence and not medical advice. It does not replace your care team. Discuss anything here with your clinician before you act on it.

What is polypharmacy?

Polypharmacy means using several medicines at the same time. NIA calls it the use of multiple drugs to treat diseases and other health conditions. There is no agreed cutoff, but the most common in research is five or more medicines a day: a 2017 systematic review in BMC Geriatrics found it in 46.4% of the articles that defined the term, with definitions running from two or more to 11 or more. The word is neutral on its own. Using many medicines can be the right care. The worry is with medicines that are excessive or unnecessary.

Why isn't there one number?

Because researchers have defined it in many ways. The BMC Geriatrics review collected 138 definitions of polypharmacy and related terms from 110 articles. About 80% were a count of medicines and nothing else. Others added how long the medicines were used or the care setting, and a few described polypharmacy in words instead of numbers. The review's authors say a count doesn't account for the other conditions a person has, which makes safety and appropriateness hard to judge, and they call for an internationally agreed definition. MedlinePlus uses five as a working marker: people prescribed 5 or more medicines are on its list of those more likely to have problems.

Which medicines count?

All of them, not only prescriptions. A medicine list is meant to cover every prescription and over-the-counter medicine, and MedlinePlus counts vitamins, supplements and herbal products as over-the-counter. FDA's As You Age page gives pain relievers, antacids, cold medicines and laxatives as examples, and says not to forget eye drops and creams or ointments. Interactions are not limited to prescriptions: FDA says one way they happen is an herbal preparation or supplement changing how another medication works.

Why does polypharmacy get attention in older adults?

Older adults tend to take more medicines, and the body handles them differently with age. NIA says people 65 and older tend to take more medicines than any other age group, often because they have several health problems at the same time. Managing many medicines can also be expensive and hard to track, especially for people who are homebound or live in rural areas. FDA says body changes can affect how medicines are absorbed and used, through changes in the digestive system or in body weight, for example, and that these changes bring a bigger risk of drug interactions among older adults.

What problems are linked to polypharmacy?

Mainly side effects, interactions and falls. Most medicines can have side effects, so the more medicines someone takes, the more likely side effects become, MedlinePlus says, and certain medicines can raise the risk of falls. An interaction is when one medicine changes how another works, for example by making it stronger, and some interactions can be serious. FDA describes drug-drug, drug-food and drug-alcohol interactions, and drug-condition interactions, where a condition someone already has makes a medicine potentially harmful. The BMC Geriatrics review notes that polypharmacy is associated with outcomes including falls and adverse drug reactions, and that the risk of harm rises with the number of medicines.

Is taking many medicines always a problem?

No. The BMC Geriatrics review says using multiple medicines may in many instances be clinically appropriate, and that the number alone doesn't show whether therapy is appropriate, since every one of them may be necessary. It points to a shift toward the term appropriate polypharmacy, to separate "many" from "too many". The concern sits on the other side of that line. NIA calls the use of excessive or unnecessary medications inappropriate polypharmacy. Deprescribing, an approach to safely reduce or stop medications that are potentially inappropriate or unnecessary, is an active research area, and the AGS notes that deprescribing studies show how much patient and family input matters.

What are the Beers Criteria?

A list clinicians use to flag medicines that may be a poor fit for older adults. The American Geriatrics Society's Beers Criteria name potentially inappropriate medications that are typically best avoided by older adults in most circumstances, or in specific situations such as certain diseases or conditions. The 2023 update is meant for adults 65 and older in ambulatory, acute and institutional care settings, with stated exceptions. NIA notes that the list covers prescription and over-the-counter medicines and is updated every three years. The criteria are sorted into five categories, including medicines to use with caution and potentially inappropriate drug-drug interactions. The AGS says its main audience is practicing clinicians, that the criteria should support rather than replace shared clinical decision-making, and that they are not to be used in a punitive manner. The BMC Geriatrics review adds that the criteria have recognized limitations, such as needing regular updates to stay clinically relevant.

Why do prescriptions from several doctors matter?

Because no single doctor may see the whole list. MedlinePlus says people who take medicines prescribed by more than one provider are more likely to have problems, since one provider may not know about medicines another has given. Seeing more than one provider can also make it more likely that someone takes a medicine they don't need. FDA's As You Age page says your primary care doctor should know about any specialists you see regularly. The pharmacy can help close the gap. Filling prescriptions at one pharmacy keeps the records in one place, which helps alert the pharmacist if a new drug might cause a problem with something else. NIA's research summary describes the burden this puts on patients and families, who need to understand the purpose of prescriptions written by multiple providers, get refills, take each medicine at the right time of day and recognize side effects.

What happens in a medication review, and what helps to bring?

It is a conversation with a doctor or pharmacist that goes through every medicine on the list and whether each one is still needed. NIA's tips for a deprescribing conversation start with making a complete and accurate list together, then asking whether any may not be necessary and whether any new symptoms could come from a medicine. FDA suggests writing down questions before the visit and thinking about bringing a close friend or relative who can help you understand and remember the answers. You could ask what each medicine is for, whether all of them are still needed, and one of NIA's own examples: "Can this drug increase my risk of falling?" When medicines come from one store and the pharmacist is told about every prescription, over-the-counter medicine and supplement, FDA says the pharmacist can help make sure they don't interact harmfully.

Sources

• NIA: Taking Medicines Safely as You Age (content reviewed September 22, 2022): NIA says the use of multiple drugs to treat diseases and other health conditions is called polypharmacy, and that it is a growing concern for older adults.
• Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics 2017;17:230: The BMC Geriatrics systematic review found the most commonly reported definition of polypharmacy was five or more medications daily (51 articles, 46.4%), with definitions ranging from two or more to 11 or more medicines.
• Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics 2017;17:230: The review says that in many instances the use of multiple medicines may be clinically appropriate, and that the specific number of drugs taken is not itself indicative of appropriateness of therapy, as all of the drugs may be clinically necessary and appropriate.
• NIA: The dangers of polypharmacy and the case for deprescribing in older adults (research highlight, August 24, 2021): NIA describes inappropriate polypharmacy as the use of excessive or unnecessary medications.
• MedlinePlus: Taking multiple medicines safely (review date 7/23/2024): MedlinePlus says people who take medicines prescribed by more than one provider are more likely to have problems from taking multiple medicines, because one provider may not know that you are taking medicines another provider has given you.
• Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics 2017;17:230: The review included 110 articles and obtained 138 definitions of polypharmacy and associated terms: 111 numerical only (80.4% of all definitions), 15 numerical definitions that incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%).
• Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics 2017;17:230: The review concludes that numerical definitions of polypharmacy do not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy, and that there is a need for an internationally agreed definition.
• MedlinePlus: Taking multiple medicines safely (review date 7/23/2024): MedlinePlus lists people who are prescribed 5 or more medicines among the people more likely to have problems from taking multiple medicines.
• MedlinePlus: Taking multiple medicines safely (review date 7/23/2024): MedlinePlus says a medicine list should include all prescription and over-the-counter (OTC) medicines, and that OTC medicines include vitamins, supplements and herbal products.
• FDA: As You Age: You and Your Medicines (content current as of 02/19/2019): FDA's As You Age page says to tell your health care professionals about all the medicines you take, including prescription and OTC medicines such as pain relievers, antacids, cold medicines and laxatives, and not to forget eye drops, dietary supplements, vitamins, herbals and topical medicines such as creams and ointments.
• FDA: 5 Medication Safety Tips for Older Adults (content current as of 02/15/2024): FDA's medication safety tips for older adults list, among the ways interactions can occur, an herbal preparation or supplement altering the way another medication works.
• NIA: Taking Medicines Safely as You Age (content reviewed September 22, 2022): NIA says people age 65 and older tend to take more medicines than those in any other age group, often because they have several diseases or other health problems at the same time.
• NIA: Taking Medicines Safely as You Age (content reviewed September 22, 2022): NIA says managing multiple medications can be expensive and difficult to track, especially for those who are homebound or who live in rural areas.
• FDA: As You Age: You and Your Medicines (content current as of 02/19/2019): FDA says that as you get older, body changes can affect the way medicines are absorbed and used, for example changes in the digestive system and changes in body weight.
• FDA: As You Age: You and Your Medicines (content current as of 02/19/2019): FDA says that because of these body changes, there is a bigger risk of drug interactions among older adults.
• MedlinePlus: Taking multiple medicines safely (review date 7/23/2024): MedlinePlus says that because most medicines can have side effects, the more medicines you take, the more likely you will have side effects, and that taking certain medicines can also increase the risk for falls.
• MedlinePlus: Taking multiple medicines safely (review date 7/23/2024): MedlinePlus says an interaction is when one medicine affects how another medicine works, for example making the other medicine stronger, and that some interactions can be serious, even life threatening.
• FDA: As You Age: You and Your Medicines (content current as of 02/19/2019): FDA describes drug-drug, drug-condition, drug-food and drug-alcohol interactions, and says drug-condition interactions happen when a medical condition you already have makes certain drugs potentially harmful.
• Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics 2017;17:230: The review says polypharmacy is associated with adverse outcomes including falls and adverse drug reactions, and that the risk of adverse effects and harm increases with increasing numbers of medications.
• Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics 2017;17:230: The review points to a shift toward the term 'appropriate polypharmacy' to differentiate between the prescribing of 'many' and 'too many' drugs instead of a simple numerical count of medications.
• NIA: Taking Medicines Safely as You Age (content reviewed September 22, 2022): NIA says researchers are studying deprescribing, an approach to safely reduce or stop medications that are potentially inappropriate or unnecessary.
• American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2023;71(7):2052-2081 (NIH PMC author manuscript PMC12478568): The AGS says deprescribing studies have demonstrated how critical patient and family input and buy-in can be.
• American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2023;71(7):2052-2081 (NIH PMC author manuscript PMC12478568): The AGS Beers Criteria is an explicit list of potentially inappropriate medications that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions.
• American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2023;71(7):2052-2081 (NIH PMC author manuscript PMC12478568): The 2023 AGS Beers Criteria are intended to be applied to adults 65 years old and older in all ambulatory, acute and institutionalized settings of care, with stated exceptions.
• NIA: The dangers of polypharmacy and the case for deprescribing in older adults (research highlight, August 24, 2021): NIA says medical professionals use the AGS Beers Criteria, which lists prescription and over-the-counter medications that older people should avoid or use with caution, and that it is updated every three years.
• American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2023;71(7):2052-2081 (NIH PMC author manuscript PMC12478568): The 2023 update organizes the criteria into five general categories, including medications to be used with caution and potentially inappropriate drug-drug interactions.
• American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2023;71(7):2052-2081 (NIH PMC author manuscript PMC12478568): The AGS says the primary target audience for the criteria is practicing clinicians, that the criteria should be applied in a manner that supports, rather than replaces, shared clinical decision-making, and that they are not to be used in a punitive manner.
• Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics 2017;17:230: The review says the Beers criteria has recognised limitations, such as requiring regular updates to ensure clinical relevance.
• MedlinePlus: Taking multiple medicines safely (review date 7/23/2024): MedlinePlus says you may take a medicine you do not need, and that this may be more likely if you see more than one health care provider.
• FDA: As You Age: You and Your Medicines (content current as of 02/19/2019): FDA says your primary care doctor should know about any specialist doctors you may see on a regular basis.
• NIA: Taking Medicines Safely as You Age (content reviewed September 22, 2022): NIA says to try to have all your prescriptions filled at the same pharmacy so your records are in one place, which will help alert the pharmacist if a new drug might cause a problem with something else you're taking.
• NIA: The dangers of polypharmacy and the case for deprescribing in older adults (research highlight, August 24, 2021): NIA says polypharmacy creates a burden for patients and their families, who need to understand the purpose of the many prescriptions written by multiple providers, get refills, take each medication at the correct time of day and recognize side effects.
• NIA: The dangers of polypharmacy and the case for deprescribing in older adults (research highlight, August 24, 2021): NIA's tips for a conversation about deprescribing include making a complete and accurate list of current medications together, asking if there are any that may not be necessary, and discussing any new symptoms and asking if any of your drugs might be causing them.
• FDA: As You Age: You and Your Medicines (content current as of 02/19/2019): FDA says it may help to make a list of comments, questions or concerns before a visit, and to think about having a close friend or relative come to the appointment to help you understand and remember answers to your questions.
• NIA: Taking Medicines Safely as You Age (content reviewed September 22, 2022): NIA's questions for a new medicine begin with "What is the name of the medicine and why am I taking it?", and NIA says to ask at each visit if you still need to be on all your medications.
• NIA: The dangers of polypharmacy and the case for deprescribing in older adults (research highlight, August 24, 2021): NIA gives "Can this drug increase my risk of falling?" as an example question about potential harms from medications.
• FDA: As You Age: You and Your Medicines (content current as of 02/19/2019): FDA says that if you buy your medicines at one store and tell your pharmacist all the OTC and prescription medicines or dietary supplements you take, your pharmacist can help make sure your medicines don't interact harmfully with one another.

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