Polypharmacy and Side Effects: How Taking Too Many Medications Increases Health Risks

When you’re taking five or more medications every day, it’s not just a routine-it’s a risk. Polypharmacy, the term for using five or more drugs at once, is common among older adults and people with chronic conditions. But what looks like proper medical care can actually be putting your health in danger. The problem isn’t always the drugs themselves-it’s how many are piled on top of each other, often without a clear plan.

Why More Medications Don’t Mean Better Health

Many people assume that if a doctor prescribes a medication, it must be necessary. But the truth is, not every pill you take is helping you. In fact, some might be making things worse. A 2016 study in BMJ Open found that people taking 10 or more medications had a 28% higher chance of dying than those taking just one to four. That’s not because the drugs are dangerous on their own-it’s because they interact, overload your body, and cause side effects that lead to new prescriptions.

Take a 72-year-old woman with high blood pressure, arthritis, and mild depression. She’s on a beta-blocker, an NSAID, an antidepressant, a statin, a diuretic, a calcium supplement, and a sleep aid. Each one was prescribed for a separate issue. But together, they’re causing dizziness, confusion, and muscle weakness. Her doctor then prescribes a balance medication for the dizziness-and now she’s on eight pills. This is called a medication cascade: one side effect leads to another drug, which causes another problem. Studies show 30-40% of inappropriate prescriptions in older adults start this way.

The Real Cost of Too Many Pills

It’s not just your body that suffers. Your wallet does too. In 2022, Medicare data showed that people taking five to nine medications spent an average of $317 per month on drugs. Those taking just one to four paid $78. For someone on a fixed income, that’s the difference between eating well and skipping meals. One patient in California told a clinic he was choosing between his heart medication and groceries. He was taking 12 pills a day-and still couldn’t afford them all.

And it’s not just money. A 2021 study in the Journal of General Internal Medicine found that patients on 10 or more medications were 3.2 times more likely to miss doses. Why? Complexity. If you can’t remember whether you took your 8 a.m. pill or your 2 p.m. one, you’ll skip them. Cost and confusion are the top two reasons people stop taking their meds. Side effects come in third.

How Polypharmacy Hits Your Body

Your body doesn’t handle drugs the same way when you’re older. Liver and kidney function slow down. Your muscles shrink. Your brain becomes more sensitive to certain chemicals. That means a dose that was safe at 50 might be dangerous at 75.

The most common side effects from polypharmacy include:

• Falls and fractures (risk increases 1.5 to 2 times with five or more meds)
• Confusion and memory problems (often mistaken for dementia)
• Extreme fatigue or dizziness
• Stomach bleeding from NSAIDs mixed with blood thinners
• Low sodium levels from diuretics and antidepressants combined

A 2019 study by the American Academy of Family Physicians found that every additional medication after the fourth one raises the risk of a serious fall. It doesn’t matter if it’s a blood pressure pill or a vitamin-each one adds to the danger.

What’s the Difference Between Good and Bad Polypharmacy?

Not all multiple medications are bad. Sometimes, you need them. For example, after a heart attack, patients are often put on four drugs: a beta-blocker, a statin, an antiplatelet, and an ACE inhibitor. This combination has been shown to cut death risk by 50-60%. That’s appropriate polypharmacy: targeted, evidence-based, and necessary.

Inappropriate polypharmacy is when you’re taking drugs that don’t help-or even hurt. Examples include:

• Taking two different painkillers that do the same thing
• Staying on a sleeping pill for years after insomnia is gone
• Prescribing an anticholinergic for allergies when a safer alternative exists
• Keeping a medication that was only meant for short-term use

The American Geriatrics Society’s Beers Criteria lists over 50 medications that should be avoided or used with extreme caution in older adults. Anticholinergics, benzodiazepines, and NSAIDs make up 45% of inappropriate prescriptions in this group.

Deprescribing: The Quiet Revolution in Medicine

There’s a growing movement called deprescribing-the careful, planned reduction or stopping of medications that are no longer needed or are doing more harm than good. It’s not about cutting pills randomly. It’s about reviewing every drug with a clear goal: improve safety, reduce side effects, and restore quality of life.

The process takes time. Most patients need 3 to 6 months to safely reduce their meds. A 2020 study found that doctors spend 25 to 40 minutes per patient just reviewing their full list-something rarely done in a typical 15-minute appointment.

Here’s how it works:

1. Make a complete list of everything you take-prescriptions, over-the-counter drugs, vitamins, supplements.
2. Check each one: Why was it prescribed? Is it still needed? Is it safe with your other meds?
3. Use tools like the Beers Criteria to flag risky drugs.
4. Start with the most dangerous or least necessary ones first.
5. Reduce slowly. Stop one at a time. Watch for changes.

One patient, a 78-year-old man on 12 medications, started deprescribing after he fell three times in six months. After removing three unnecessary drugs-including a sleep aid and an old antidepressant-he stopped feeling dizzy. His balance improved. He started walking again.

What You Can Do Right Now

You don’t need to wait for your doctor to bring it up. You can take control today:

• Bring every pill bottle to your next appointment-even the ones you haven’t taken in months.
• Ask: “Is this still helping me? Could it be causing any of my symptoms?”
• Ask about alternatives: “Is there a safer drug or a non-drug option?”
• Request a full medication review if you’re on five or more drugs.
• Use a pill organizer-but only if you know what’s in it.

Medicare now requires pharmacies to review medications for people taking eight or more drugs. Ask your pharmacist to walk you through your list. They’re trained to spot interactions.

The Bigger Picture: Why This Is a System Failure

Polypharmacy isn’t just about individual choices. It’s a system problem. Most doctors don’t get enough training in managing complex medication regimens. Only 12% of medical schools in the U.S. have a dedicated course on polypharmacy. Primary care doctors report that only 28% have systems in place to track complex drug lists.

The FDA approved its first deprescribing decision tool, MedWise, in 2022. It flagged dangerous combinations and reduced risky drug pairs by 37% in early trials. But tools like this aren’t widely used yet.

The cost of inaction is huge. Polypharmacy causes $300 billion in avoidable healthcare spending each year in the U.S. That includes hospital stays, ER visits, and long-term care. Patients on multiple drugs have 24% more hospital admissions and 32% more emergency visits than those on fewer meds.

It’s Not About the Number-It’s About the Need

Some experts argue that focusing on the number five is arbitrary. The real question isn’t “How many pills?” but “Are these pills helping you live better?”

A 70-year-old with heart failure, diabetes, and kidney disease might need seven medications to stay alive. That’s not polypharmacy-it’s life-saving care.

But a 75-year-old taking a daily sleep pill, an antacid, a muscle relaxant, a vitamin D, a calcium supplement, and a cholesterol drug-all because they were added over time without review-that’s the problem.

The goal isn’t to take fewer pills. It’s to take the right ones.

What Happens When You Don’t Act

Without changes, the problem will only get worse. By 2035, researchers predict polypharmacy will increase adverse drug events by 40% and add $127 billion to annual healthcare costs.

But change is possible. The American Geriatrics Society’s “Choosing Wisely” campaign reduced inappropriate prescribing by 22% in just two years. Patients who worked with their doctors to deprescribe reported better sleep, more energy, and fewer falls.

The message is clear: More pills don’t mean better health. Sometimes, less is more.