By: Dr. Carolyn Rodríguez Rivera, PharmD
MCS Pharmacy Executive Vice President

Polypharmacy, or the simultaneous use of multiple drugs, is predominant in seniors with chronic conditions that are managed with medications prescribed by more than one physician. Taking multiple drugs simultaneously increases the risk of adverse events and serious health complications, which can increase hospitalizations and healthcare costs.

Some medications, especially the ones that act on the central nervous system (CNS) and anticholinergics (AHCs), are considered inappropriate to prescribe to older adults. This is due to age-related pharmacokinetic and pharmacodynamic changes that can cause potential side effects and increase the risk of prolonged sedation and falls.

Drugs Acting on the Central Nervous System (CNS)	Anticholinergic Drugs (ACH)
Antipsychotics Sedatives/hypnotic benzodiazepines and non-benzodiazepines Opioids Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants Antiepileptics	Antihistamines Antiparkinsonian agents Musculo-skeletal relaxants Antidepressants Antipsychotics Antiarrhythmics Antimuscarinics (urinary incontinence) Antispasmodics Antiemetics

Although more research is needed to better describe the impact of drug use on the functional state of the elderly, current data validates the need to reduce and discontinue unnecessary or dangerous drugs in this population. Anticholinergics have been consistently associated with impaired functionality in seniors, along with drugs that act on the central nervous system.

Identifying polypharmacy in a senior provides opportunities to optimize the person’s treatment, and discontinue some drugs (i.e. central nervous system drugs associated with adverse effects in the population).

In an effort to reduce polypharmacy, the Centers for Medicare and Medicaid Services (CMS) has implemented quality measures to address the use of multiple drugs. These measures make it possible to identify at-risk patients and properly manage their therapy in order to avoid serious complications. As a result, we’re complying as healthcare professionals by providing a safe and effective treatment for our patients.

During the medical consultation, it’s essential to monitor adverse drug reactions of patients with multiple conditions and review their dosages. Undoubtedly, a clinically appropriate reduction in the number of drugs, dosage and frequency is essential in reducing drug harm and preventable adverse events in seniors, and ensure their safety.