Polypharmacy: definition, risks, management

Abstract

A search was performed in the Scopus, Web of Science, MedLine, The Cochrane Library databases. The term “polypharmacy”, in contrast to the term “polypragmasia”, does not always has a negative meaning and is often used to describe the simultaneous use of five or more drugs, and polypharmacy is considered intensive, when the patient takes 10 or more drugs at the same time. One of the main causes of polypharmacy is polymorbidity. Severe condition of the patient, self-medication and inappropriate recommendations can also cause polypharmacy, as well as some demographic factors (age, gender, level of education) and the level of the health care system development. Polypharmacy can be appropriate when the prescription of a large number of drugs is justified, and inappropriate (problematic) when the number of prescribed drugs is incorrect and/or unbalanced. Problematic polypharmacy is a manifestation of polypragmasia, with several drugs prescribed improperly that does not allow realizing the expected advantage of these drugs. The risk of harm from treatment outweighs the benefits due to drug interactions, adverse reactions, increasing economic burden of treatment. Problematic polypharmacy is especially dangerous for critically ill patients. The management of problematic polypharmacy should be based on its transition into an appropriate form. The combination of drugs is substantiated, which allows treating the patient effectively, safely and economically expediently through the prevention of drug interaction and adverse effects. Deprescribing of certain drugs can be used as a therapeutic intervention, it should be performed in each individual patient through the assessment of benefits and risks. Beers criteria, ARMOR, STOPP-START criteria are offered for prevention and correction of problematic polypharmacy in the elderly.