Medication overload: How to avoid harm from too many meds

By Judith Garber | August 8, 2024

Five years after the Lown Institute’s report on medication overload was published, this issue continues to be relevant in American health care, garnering attention recently in a widely syndicated AP News report.

Medication overload, when the harms from taking multiple medications outweigh the benefits, has greatly increased in the U.S., particularly for adults over 65. More than four in ten older adults take five or more prescription medications, and nearly 20 percent take ten drugs or more.

Hundreds of older Americans are hospitalized each day due to adverse drug events from one or more medications.

What are the harms of medication overload?

Too many medications can lead to adverse drug events such as delirium, bleeding, falls, and even hospitalization or death. For each additional drug in a patient’s medication regimen, the risk of adverse drug events increases by 7 to 10 percent.

A common cause of overmedication is the “prescribing cascade,” in which patients are prescribed a drug to treat the side effects of another drug, which leads to more side effects and more drugs, and so on. That’s what happened to Joe Esposito, a late patient featured in the Lown Institute’s 2019 medication overload report. When Joe sought treatment for his mild to moderate Crohn’s disease, his list of medications cascaded from one to six to twenty, as each new medication brought on a new side effect. At the end of his life, Joe was taking over 20 medications and 31 pills a day, leaving his family wondering if his drugs were helping or actually contributing to his debilitating condition.

As we get older, drugs affect us differently, so drugs prescribed years ago can have greater risk of harm than when they were first prescribed. For example, sedative hypnotics such as benzodiazepines (anti-anxiety medications) increase the risk of falls, fracture, and cognitive impairment in older adults. Anticholinergic drugs— a class of drugs that include anti-allergy, motion sickness medications, and many others– can cause hallucinations, confusion, tachycardia, dry eyes, and other adverse effects, which become more pronounced in combination with each other.

Patients may be prescribed medications to reach a certain guideline-recommended target for a chronic condition, such as blood sugar, blood pressure, or cholesterol. However, if these treatments are overly intensive, the harms from side effects can outweigh the benefits. For example, use of multiple diabetes medications can lead blood sugar to drop too low, increasingrisk for falls, fractures, confusion, seizures, and hospitalization.

How can you avoid medication overload?

Always keep an up-to-date list of your medications, including over-the-counter drugs and supplements.

If you are experiencing harmful side effects from medication overload, or are having trouble managing your pills, ask your primary care provider for a “prescription checkup.” This checkup is an opportunity to discuss any side effects you’re concerned about, and identify any unnecessary or potentially harmful medications you can stop or taper.

Before adding another medication to your regimen, you can ask your doctor these questions:

What is this medication for?
How will we know when the medication is working or not working?
When should I stop taking this medication?
Are there side effects I should watch out for if I take this medication?

The policy changes we need to stop medication overload

Many of the drivers of medication overload are reflected in our health care system more broadly: Our “more care is better” philosophy, fragmentation of care with low communication across care sites, and lack of regulation of the pharmaceutical industry all contribute to medication overload.

Along with tips for patients, the Lown Institute action plan recommends coverage for medication reviews with a deprescribing focus, education and training for health professionals on how to avoid medication overload and deprescribe, tools at the point of care to avoid medication harm, and policies to reduce the influence of the pharmaceutical industry such as limiting sales rep visits and direct-to-consumer advertising.

To eliminate medication overload, serious cultural, educational, and policy changes are needed. This action plan offers recommendations for policymakers, health care institutions, clinicians, and patients across five key categories to reduce harm from multiple medication use. Suggested Citation: Eliminating medication overload: A national action plan. Working Group on Medication Overload. Brookline, MA: The Lown Institute, 2020. DOI: https://doi.org/10.46241/LI.YLBW4885

Pharmaceutical marketing is a significant factor in the growing public health crisis of medication overload, which puts millions of older adults at risk of preventable harm and premature death. This issue brief provides recommendations to reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.

This issue brief provides recommendations for clinical practice guidelines and electronic health records that would give clinicians the information they need to appropriately prescribe and deprescribe.