With the Philippine population projected to become an aging society by 20301, understanding polypharmacy has never been more critical. As a pharmacist, your role in managing polypharmacy will only grow more important.
In this article, we'll discuss what polypharmacy is, the challenges and opportunities it presents, and how you can make a meaningful impact in safeguarding your patients' health.
What is polypharmacy and why is this a major challenge in Medication Safety?
Polypharmacy is the practice of regularly taking five or more medicines at a time2. It remains to be a major challenge in medication safety. You are likely to encounter polypharmacy in3:
- Older adults, especially those with multiple chronic conditions
- Patients with cognitive and developmental disabilities
- Those managing multiple chronic conditions (such as diabetes, cancer, or cerebrovascular disease)
- Individuals in long-term care facilities
In the Philippines, studies show that polypharmacy affects approximately 37% of the elderly population4.
Pharmacotherapy for Chronic Illnesses and How This Leads to Polypharmacy
The path to polypharmacy often begins with legitimate therapeutic needs. As patients age and develop multiple chronic conditions, each condition typically requires specific pharmacological intervention, leading to an accumulation of medications over time.
Several healthcare system factors compound this issue.
First, the concept of a primary care physician isn't yet widely established in the country5. Patients may consult different doctors depending on availability, situation, or preference: visiting a walk-in clinic one time and deciding for an online consultation the next. Each physician may prescribe valid medications without knowledge of what others have prescribed, creating a fragmented medication profile.
Referrals may also be an issue. A single emergency room visit can result in referrals to several specialists who may not communicate with one another about the same patient.
Finally, patients may self-administer over-the-counter (OTC) medications regularly: pain relievers, antihistamines, and supplements that may not appear in any medical record but significantly impact their overall drug regimen.
Risks of Overusing Medicines
Polypharmacy occurs given the need to treat various health conditions. However, multiple medications inherently carry risks, particularly for older patients.
Aging brings about physiological changes that may affect how we absorb, metabolize, and eliminate drugs. These may affect not just the effectiveness of the drug but also medication safety.
Moreover, polypharmacy also increases the risks of drug interactions, adverse drug reactions, and drug-food interactions, all of which can compromise patient safety. For instance, there’s prescription cascades or “the need to treat the previous problem caused by a prescribed medication with a new medication.”4
Beyond clinical risks, polypharmacy may significantly diminish your patients' quality of life due to:
- Increased healthcare utilization: More frequent doctor visits, higher hospitalization rates, and greater healthcare burden3.
- Mobility and safety concerns: Elevated fall risk due to medication side effects like dizziness, weakness, confusion.6
- Loss of independence: Growing reliance on family members for medication management and daily activities.4
Finally, there are also studies suggesting that polypharmacy is a huge factor in potentially inappropriate medication in hospitalized older adults7.
Pharmacists’ Crucial Role in Ensuring Patients Receive the Right Medications at the Right Time
Pharmacists are recognized as drug experts with comprehensive knowledge of therapeutic uses, dosage regimens, precautions, adverse effects, and proper storage requirements. This expertise uniquely positions you within the healthcare team to identify and prevent medication-related problems8.
Research confirms that 100% of surveyed Filipino pharmacists believe interprofessional collaboration improves patient care. Yet despite this conviction and the industry’s clinical expertise, pharmacists’ role in comprehensive medication management may remain underutilized, especially in community pharmacy settings9.
To help support you in your expanded role is the legal framework of the Philippines' Pharmacy Act (R.A. 10918). This mandates that all prescriptions and pharmacist-only OTC medicines must be filled, compounded, and dispensed exclusively by registered and licensed pharmacists. This gives you both the authority and responsibility to ensure medication safety for your patients.10
How do you identify, manage, and optimize polypharmacy?
Conduct medication interviews
Conducting thorough medication interviews before dispensing is a huge step toward ensuring medication safety. A comprehensive medication review allows you to assess not only the effectiveness and safety of each drug but also its appropriateness for your patients.
In a randomized controlled trial by Gillespie et al., comprehensive medication reviews of older hospitalized patients resulted in 16% fewer hospital visits, 47% fewer emergency department visits, and an 80% reduction in medication-related readmissions within 12 months11.
Facilitate clear communication with patients
Effective communication becomes especially crucial when discussing complex medication regimen, especially with elderly patients who may have visual or cognitive limitations.
You must explain not only what medications to take and when, but also why each is necessary, which side effects to monitor, and what signs warrant immediate medical attention. In the Philippines, where socioeconomic factors and cultural beliefs about traditional medicine influence adherence, this educational role becomes even more vital.
Collaborate with other healthcare professionals to protect patient safety
Effective polypharmacy management thrives on teamwork. When you work closely with physicians and nurses, you achieve better medication outcomes and enhance patient safety.
Maintaining accurate medication lists, flagging potential interactions, and supporting patients through care transitions ensure continuity and prevent errors. International evidence confirms the impact: multidisciplinary deprescribing interventions can reduce inappropriate medication use by 59% and mortality by 26%.12
At Unilab, we help promote the safe use of medicines—especially for patients taking multiple medications—by ensuring that potential drug-to-drug interactions are carefully identified and clearly communicated. This includes maintaining up-to-date, clinically relevant interaction information in our official product safety documents.
Part of our efforts also include accurate labeling, continuous monitoring of safety data from spontaneous reports, scientific literature, post-marketing studies, and regulatory databases. These efforts support thorough benefit–risk assessments, particularly for populations more vulnerable to polypharmacy, such as older adults, patients with chronic conditions, and those managing multiple treatments.
As the Philippines moves toward an aging society, your role in managing polypharmacy will become increasingly vital to patient safety and healthcare quality. Conducting thorough medication reviews, communicating effectively with patients, and collaborating with healthcare teams means you're not just dispensing medications, you're preventing harm and improving lives.
Your doctor will always be in the best position to give the appropriate medical advice for your condition. For suspected undesirable drug reaction, seek medical attention immediately and report to the FDA at www.fda.gov and UNILAB Inc. at 8-UNILAB-1 or productsafety@unilab.com.ph. Always buy your medicine from your trusted drugstores and retailers
References:
1. Better care for aging Pinoy population – University of the Philippines Diliman | Better Care for Aging Pinoy Population
2. Polypharmacy – NCBI Bookshelf | Polypharmacy - StatPearls
3. Polypharmacy: Evaluating Risks and Deprescribing – American Academy of Family Physicians (AAFP) | Polypharmacy: Evaluating Risks and Deprescribing
4. Quality of Life of Elderly Patients with Polypharmacy in the Out-Patient Department of a Tertiary Hospital – Philippine Academy of Family Physicians | Quality of Life of Elderly Patients with Polypharmacy in a Tertiary Hospital
5. Experiences from the Philippine grassroots: impact of strengthening primary care systems on health worker satisfaction and intention to stay – BMC Health Services Research | Strengthening Primary Care Systems in the Philippines
6. Polypharmacy in Adults 60 and Older – Johns Hopkins Medicine | Polypharmacy in Adults 60 and Older
7. Appropriateness of Medication Prescribing in Hospitalized Older Adults in a Tertiary Teaching Hospital in the Philippines: A Cross-Sectional Study – PubMed Central (PMC) | Appropriateness of Medication Prescribing in Hospitalized Older Adults in the Philippines
8. Roles and Identity of Community Pharmacists in the Philippine Rural Setting – Online Scientific Research | Roles and Identity of Community Pharmacists in the Philippine Rural Setting
9. Pharmacists’ Extent of Agreement and Level of Satisfaction on Interprofessional Collaboration with Physicians: Achievement of an Effective Medication Therapy Management in Selected Regions in the Philippines – GSC Biological and Pharmaceutical Sciences | Pharmacists’ Interprofessional Collaboration in the Philippines
10. REPUBLIC ACT NO. 10918, July 17, 2016 – Judiciary eLibrary | Republic Act No. 10918 (Philippine Pharmacy Act of 2016)
11. Medication safety in polypharmacy – World Health Organization (WHO) | Medication Safety in Polypharmacy
12. Deprescribing as a strategy for improving safety of medicines in older people: Clinical and regulatory perspective – Frontiers in Drug Safety and Regulation | Deprescribing to Improve Medication Safety in Older People
