Polypharmacy and Self-Medication: Understanding the Risks and Prevention

We have all used or considered self-medication at least once in our lives. Whether it's over-the-counter painkillers, antibiotics without a prescription or herbal preparations, self-medication has become a common practice. This may seem or sound harmless for minor ailments, but the uncontrolled use of medication can have serious consequences.

One of the most worrying consequences of self-medication is polypharmacy, i.e., to put it simply, the simultaneous intake of several medications, often without adequate medical supervision. The risks associated with polypharmacy include adverse drug interactions, increased side effects, reduced effectiveness of treatments and, in severe cases, life-threatening complications. Hence, it is important to have a good understanding of the risks and prevention of self-medication and polypharmacy.  

What is Polypharmacy? 

Polypharmacy is the simultaneous intake of several medications by an individual, especially if these medications are not adequately monitored. It can affect different age groups, but some people are at higher risk than others, such as the elderly, people with chronic illnesses and people who self-medicate. 

Causes of Polypharmacy 

Polypharmacy can be caused by a variety of factors, which can range from medical necessity to poor coordination of healthcare.

• Chronic illnesses requiring multiple prescriptions 

• Multiple healthcare providers prescribe different medications 

• Self-medication and over-the-counter drug use 

• Lack of medication review 

• Patient misunderstanding or pressure

Chronic Illnesses Requiring Multiple Prescriptions 

Chronic conditions such as diabetes, high blood pressure and heart disease often require multiple medications for symptom control. Over time, the number of medications prescribed can increase, leading to a higher risk of polypharmacy. 

Multiple Healthcare Providers Prescribing Different Medications 

If the individuals visit many consultants for various conditions, there is a chance that each consultant may prescribe a drug without being aware of the individual's existing prescriptions. This can result in duplication of medication, unnecessary therapy or toxic drug interaction. 

Self-medication and Over-the-counter Drug Use 

Most people take over-the-counter medicines or dietary supplements without consulting a doctor. This practice can lead to interactions with other medications, unwanted side effects, or even reduced effectiveness of the prescribed medication 

Lack of Medication Review 

Regular examination or review of the medicines or the prescription by a health care professional is quite important, ensuring that the medicines are still needed and working.  Without having regular reviews, individuals may be kept on unwanted medication, which may lead to polypharmacy. 

Patient Misunderstanding or Pressure 

Some people use their medication incorrectly or dose it incorrectly because they do not understand it. In addition, some individuals unnecessarily demand prescription drugs because they believe that taking more drugs will improve their health faster. Polypharmacy is sometimes exacerbated by individuals who insist on taking their medication even when it is no longer needed. 

Risk Factors of Polypharmacy 

There are several factors that can increase the likelihood of polypharmacy, including:

• Age-related changes in drug metabolism 

• Chronic medical conditions requiring multiple medications 

• Limited communication between multiple healthcare providers 

• Use of over-the-counter and herbal supplements 

• Lack of medication reviews or deprescribing practices 

• Cognitive impairment leading to medication mismanagement 

• Social and cultural habits that encourage excessive medication use

Who is at Risk of Polypharmacy? 

In the case of polypharmacy, some groups of people are more at risk and vulnerable, and they are: 

Elderly Individuals 

Older people are particularly at risk due to age-related physiological changes, reduced drug breakdown and co-occurring health conditions which require medication. Due to polypharmacy, the rate of hospitalisation, falls, and cognitive impairment is also quite high in elderly people. 

People with Multiple Medical Conditions 

People with multiple health conditions or chronic illnesses usually take multiple medications to address each condition, which makes the treatment plan a little more complicated. These combinations of medication can cause adverse reactions, and it is more likely to happen if coordination is lacking. 

Those Using OTC and Herbal Medicines Alongside Prescriptions 

Many people take herbal remedies and over-the-counter medicines without informing their doctor. These substances can interfere with prescription medications and cause unexpected side effects or reduce the effectiveness of the medication. 

Patients Seeing Multiple Specialists Without Medication Coordination 

Sometimes, individuals consult multiple doctors, and when they do so, healthcare providers may receive conflicting prescriptions, leading to medication overdose. Without proper monitoring, unnecessary or interfering medications may be prescribed, increasing health risks.

Differences Between Polypharmacy & Self-Medication 

SM and polypharmacy are usually mentioned co-jointly, mainly because of their effect on drug safety, but they differ vastly in many aspects. Some of the major differences are in their causes, monitoring and their risk. Polypharmacy is usually referred to as medicines prescribed by doctors.  Self-medication is quite the opposite, wherein there's no advice or prescription taken from any specialist.

Definition 

Polypharmacy is the simultaneous intake of several medications by a single person, often necessary for the treatment of chronic diseases. It can be beneficial if properly monitored, but it also carries risks if the medications are unnecessary or not monitored.

Self-medication, on the other hand, is the use of medication without a doctor’s prescription or advice. This includes over-the-counter medications, herbal supplements and leftover prescriptions from previous illnesses. 

Supervision 

Polypharmacy usually requires prescribing by healthcare professionals who monitor drug interactions and adverse effects. Pharmacists and doctors are at the centre of medicine management for individual safety.

Self-medication takes place without medical supervision. People decide to take medication based on a symptom, an experience or a recommendation from non-clinical providers such as friends or the internet. 

Risk Level 

Polypharmacy can indeed be beneficial with proper supervision, but it still carries risks, especially if multiple prescriptions lead to harmful interactions. If medication is not regularly reviewed, unnecessary prescriptions may accumulate, increasing the risk of side effects.

Self-medication is more risky as people may take incorrect dosages, combine medications that should not be taken together or continue taking medication for longer than necessary. 

Potential Consequences 

The consequences of polypharmacy include adverse drug reactions, increased hospitalisation and a deterioration in health if medication is mismanaged.  People who are a little older are particularly at risk due to their slow metabolism and lower tolerance to medication. 

Self-medication also harbours risks like incorrect dosage, dependence, delayed diagnosis of serious illnesses and dangerous drug interactions. In severe cases, self-medication can lead to poisoning, organ damage or life-threatening allergic reactions. 

The Dangers of Polypharmacy and Self-Medication 

Both polypharmacy and self-medication harbour considerable health risks. While polypharmacy increases the risk of interactions and side effects, self-medication can lead to addiction, overdose and misdiagnosis.

Statistics at a Glance on Self-Medication 

11-92% global prevalence of self-medication 

53.57% prevalence of self-medication in India 

26.31% prevalence was noticed in middle-lower class families (India) 

Familiarity with the medication seems to be the major reason 

Effects of Polypharmacy in the Elderly 

Older adults are particularly vulnerable to the effects of polypharmacy due to age-related changes in metabolism and organ function. Risks associated with polypharmacy in this group include: 

Cognitive impairment 

Taking multiple medications at the same time can lead to confusion, memory loss and difficulty concentrating. Certain medications, such as tranquillisers or painkillers, may exacerbate cognitive decline and increase the risk of dementia-like symptoms. 

Increased risk of falls and fractures 

Many medications impair balance and coordination, which increases the likelihood of falls. Sedatives, antihypertensive drugs and muscle relaxants can contribute to dizziness, which can lead to fractures and other injuries. 

Higher chances of hospitalisation 

Polypharmacy is associated with a higher rate of hospitalisation. Adverse drug reactions, overdoses and improper medication use can lead to serious health complications that require emergency care. 

Adverse drug interactions 

If you take multiple medicines at the same time, there is a higher chance of severe drug interactions. Some drugs may work against each other, which reduces their efficacy and may cause side effects, consequently leading to other serious health problems.  

Worsening of existing medical conditions 

Rather than improving health, overuse of medication can exacerbate existing medical conditions. For example, unnecessary painkillers can lead to kidney damage, while long-term use of tranquillisers may contribute to depression and anxiety disorders. 

Dangers of Self-Medication 

Although self-medication is widespread, it harbours serious risks. Without professional guidance, individuals may take the wrong dosages, develop dependence or fail to recognise underlying medical conditions.

Increased dependency and addiction risk 

Frequent use of painkillers, tranquillisers or stimulants without medical supervision can lead to dependence. Over time, higher doses may be required to achieve the same effect, which increases the risk of dependence. 

Incorrect dosages leading to toxicity 

Self-medication may lead to incorrect doses, resulting in overdose or poisoning. Excessive intake of medications such as paracetamol can lead to liver failure. 

Masking of serious illnesses 

By treating symptoms without addressing the actual cause, self-medication can delay the correct diagnosis. This can be particularly dangerous for conditions such as infections, heart disease or neurological disorders where early intervention is crucial. 

Severe allergic reactions or interactions with prescribed medications 

Mixing prescription medicines with over-the-counter medicines or herbal remedies can cause allergic reactions or life-threatening interactions with other medicines. Without professional advice, people may unknowingly combine substances that should not be taken together.

How to Prevent Polypharmacy: Strategies to Reduce Excessive Medication Use 

Prevention of polypharmacy demands proactive intervention on the part of both individuals and healthcare providers. Medication must be monitored and managed in a careful manner to guarantee safety and efficacy with minimal use of unnecessary medication. The following are important strategies for mitigating the risks of polypharmacy. 

Regular Medication Reviews with Healthcare Providers 

One of the best ways to avoid polypharmacy is to review medication regularly. All medicines an individual is taking should be reviewed by healthcare professionals at regular intervals to identify them: 

• Needless prescriptions which can be withdrawn. 

• Possible drug interactions that can be harmful. 

• Outdated prescriptions that are no longer needed. 

• Medication reviews ensure that individuals receive only the medication they need and that unnecessary or harmful medications are eliminated. 

Medication Management Plans 

Developing an individualised medication plan can help reduce the overuse of medication. These plans include:

• Maintaining a comprehensive medication list, including dosages and intended uses. 

• Setting up reminders or pill planners to avoid missed or duplicate doses. 

• Coordinating with the primary healthcare provider to ensure that all prescriptions are consistent with the individual’s medical condition. 

• Proper medication management improves adherence to prescribed treatments while reducing the risk of errors. 

Avoid Over-the-Counter Drugs Without Medical Advice 

Self-medication with over-the-counter medications can contribute to polypharmacy by taking additional, often unnecessary, medications. Individuals should:

• Consult a physician before taking over-the-counter medications, dietary supplements or herbal remedies. 

• Avoid combining medications without professional guidance. 

• Be careful about masking symptoms, as over-the-counter medicines may hide underlying conditions that require medical attention. 

• Uncontrolled use of over-the-counter medicines increases the risk of interactions and adverse effects, especially in older people. 

Educate Patients & Caregivers 

Many cases of polypharmacy are due to a lack of awareness among individuals and their carers. Education can help the individual:

• Understand the risks of taking excessive medication and its potential side effects. 

• Ask questions at doctor visits to clarify the need for each medication. 

• Recognise the symptoms of adverse drug reactions such as dizziness, confusion or weakness. 

• Carers, especially those looking after older people, should also be informed about the correct use of medication and possible warning signs of polypharmacy. 

Lifestyle Modifications 

In some cases, lifestyle changes can reduce the need for excessive medication. Instead of relying solely on medication, those affected can:

• Eat a healthier diet to manage conditions such as diabetes or high blood pressure. 

• Engage in regular physical activity to improve heart health and mobility. 

• Use stress management techniques such as meditation or therapy to reduce reliance on tranquillisers or antidepressants. 

• A balanced lifestyle can promote long-term health while reducing dependence on medication. 

Use of a Single Pharmacy for all Prescriptions 

Using a single pharmacy for all prescriptions ensures better medication tracking and reduces the risk of duplicate or conflicting prescriptions. Pharmacists can:  

• Monitor interactions between medications. 

• Provide detailed medication instructions. 

• Alert individuals and doctors to possible side effects. 

How to Identify Polypharmacy 

By having a basic understanding of polypharmacy, you can take action or prevent complications even before it starts. We have listed a few checklists that will help you understand if a person is taking excessive amounts of medication.  

Using Five or More Medications Simultaneously 

Regular use of multiple prescription medications may indicate polypharmacy, especially if the medications overlap. 

Experiencing Unexplained Side Effects 

Symptoms such as dizziness, confusion, nausea or weakness may be due to interactions with other medications or excessive medication intake. 

Frequent Hospital Visits Due to Adverse Drug Reactions 

If emergencies or hospitalisations occur due to medication-related problems, this may indicate that the medication needs to be reviewed. 

Difficulty Managing Medication Schedules 

Forgetting doses, taking tablets at the wrong time or being unable to keep track of prescriptions all indicate an overdose. 

Taking Medications that Interact Negatively with Each Other 

Some medications can cancel out each other’s effects or cause dangerous side effects when taken together. Individuals should regularly check for possible interactions with other medications.

Polypharmacy in Mental Health Treatment 

Experts dealing with mental health usually prescribe several medications which help in treating complicated mental health conditions. This is, to a great extent, opposite to the other medical specialities. However, polypharmacy in psychiatry is associated with particular risks that need to be carefully considered. 

Why Psychiatric Patients are Often on Multiple Medications

Individuals with severe mental conditions such as schizophrenia, bipolar disorder and major depressive disorder often require more than one medication to stabilise their symptoms. Reasons for psychiatric polypharmacy include:

• Different medications for different symptoms – A single medication cannot cover all aspects of a mental disorder. For example, a person with schizophrenia may need both an antipsychotic for hallucinations and a mood stabiliser for emotion regulation. 

• Treatment of side effects – Some psychotropic drugs cause side effects such as tremors, agitation or weight gain, so additional medication may need to be prescribed to treat these problems. 

• Treatment resistance – If an individual does not respond to a single medication, multiple medications may be prescribed in combination to achieve better results. 

• Co-morbid conditions – Many psychiatric patients also struggle with anxiety, insomnia or physical problems that require additional medication. 

Risks of Antidepressant, Antipsychotic, and Sedative Combinations 

Care should be taken when combining psychotropic drugs, as certain interactions with other medications can lead to serious side effects. Some of the most important risks are:

• Increased risk of sedation and cognitive impairment – The combination of antipsychotics and sedatives can lead to extreme drowsiness, confusion and difficulty performing daily activities. 

• Higher likelihood of metabolic disorders – Some antidepressants and antipsychotics can lead to weight gain, diabetes and cardiovascular problems. 

• Greater potential for dependence – Sedatives and certain antidepressants can lead to dependence and withdrawal symptoms if abused. 

• Risk of serotonin syndrome – Taking multiple antidepressants can lead to an excessive build-up of serotonin in the brain, which can result in agitation, tremors, high fever and, in severe cases, death. 

The Role of Caregivers in Managing Polypharmacy 

Carers are crucial in ensuring that people taking multiple medications do so safely and effectively. Without proper management, individuals may experience adverse drug reactions, incorrect dosing or lack of adherence. 

How Family Members & Caregivers Can Help Patients Manage Medication Safely 

Carers can help prevent complications from polypharmacy by:

• Ensuring adherence to therapy – reminding individuals to take medications in the correct dosage on time. 

• Communicating with healthcare providers – keeping physicians informed of any side effects or concerns about prescribed medications. 

• Monitoring for side effects – observing individuals for signs of drowsiness, confusion or unusual behaviour that could indicate an adverse reaction. 

• Encouraging regular medication reviews – helping individuals schedule regular check-ups to reassess their prescriptions and discontinue unnecessary medications. 

The Importance of Medication Tracking Apps & Pill Organisers 

Technology has made medication management easier for both individuals and carers. Here are some useful tools:

• Medication tracking apps – These apps send reminders and alerts to ensure medications are taken on time.  

• Pill planners – These can be weekly or monthly planners that help sort medication by day and time, reducing the risk of missed or duplicate doses. 

Caregiver Red Flags to Watch For

Carers should look out for warning signs that indicate that an individual is struggling with polypharmacy, e.g.:

• Confusion or disorientation – Sudden memory loss, difficulty following conversations, or difficulty recognising people. 

• Excessive sleepiness or lethargy – Sleeping too much or having difficulty staying awake during the day. 

• Unexplained falls or dizziness – An increase in falls, imbalance or difficulty walking. 

• Noticeable personality changes – mood swings, aggression or withdrawal from social contact. 

When to Seek Professional Help for Medication Management 

Certain warning signs indicate that professional intervention is required to manage medication safely. It is important to ask a doctor for help if: 

• Side effects interfere with daily life – Persistent nausea, dizziness, confusion, or weakness are present. 

• New medications are prescribed frequently – If a person’s medication list is getting longer and longer without significant improvement. 

• Multiple doctors are involved – Different specialists prescribe medications without proper coordination. 

• A dependence on tranquillisers or painkillers develops – An increasing need for higher doses to achieve the same effect. 

• There are hospitalisations due to medication complications and emergency admissions due to adverse drug reactions. 

Breaking Free from the Dangers of Polypharmacy and Self-Medication: Get Support at Cadabam’s Anunitha 

Polypharmacy and self-medication are major problems not only in India but all over the world that require awareness and proactive action. The risks associated with excessive medication intake range from side effects to dependence and can be minimised through measures such as regular medical monitoring or supervision, involvement of caregivers and informed decision-making.

At Cadabam’s Anunitha, we have a range of professionals specialising in medication management, psychiatric treatment and addiction recovery. Whether an individual is struggling with multiple prescriptions, medication dependence or concerns about side effects, tailored support is available to ensure safe and effective treatment.

If you are searching for a solution to your problem, Cadabam’s Anunitha’s De-Addiction Centre can help you with its team of specialised experts. We have been helping thousands of people live healthier and happier lives for 30+ years. We leverage evidence-based approaches and holistic treatment methods to help individuals effectively manage Polypharmacy and Self-medication. Get in touch with us today. You can call us at +91 96111 94949.

FAQs

How do prescription drugs lead to addiction? 

Addiction occurs when prescription drugs are abused, leading to dependence due to their effects on brain chemistry. Tolerance is developed through. 

What can happen if you take too many prescription drugs? 

Overdose, severe side effects, organ damage and life-threatening conditions can be caused by excessive consumption of prescription drugs. The body's ability to function is impaired and hospitalisation or fatal consequences may occur. 

What can polypharmacy lead to? 

Increased side effects, drug interactions, reduced medication effectiveness, and higher hospitalisation risks are caused by polypharmacy. Cognitive impairment and adverse health outcomes may also be experienced, especially in elderly individuals. 

How to identify polypharmacy in the elderly? 

Multiple prescriptions, frequent side effects, confusion, dizziness and difficulties in managing medication are observed in older people with polypharmacy. Medication lists are reviewed and unnecessary medications are identified by healthcare providers to avoid complications.