Polypharmacy and Side Effects: How Taking Too Many Medications Raises Your Risk

More than 40% of adults over 65 in the U.S. take five or more medications every day. That’s not just common-it’s dangerous. Taking multiple drugs might seem necessary when you’re managing heart disease, diabetes, arthritis, and high blood pressure all at once. But the more pills you swallow, the higher your chance of falling, getting hospitalized, or even dying from something preventable. This isn’t theoretical. It’s happening to real people right now.

What Exactly Is Polypharmacy?

Polypharmacy isn’t just having a few prescriptions. It’s defined as taking five or more medications regularly. That includes prescription drugs, over-the-counter painkillers, vitamins, and herbal supplements. It’s not always bad-sometimes you need all of them. But too often, medications are added without stopping others. A patient gets a new pill for sleep, then another for the dizziness it causes, then another for the stomach upset from that one. This is called a medication cascade, and it accounts for 30-40% of unnecessary prescriptions in older adults.

Doctors aren’t being careless. They’re responding to symptoms, guidelines, and time constraints. But when you’re juggling 10+ pills, no one is looking at the whole picture. The American Geriatrics Society says 91% of adverse drug events in seniors are tied to polypharmacy. That’s not a coincidence. It’s a system failure.

How More Medications Lead to More Side Effects

Your body doesn’t handle drugs the same way when you’re 75 as it did when you were 45. Liver and kidney function slow down. Your brain becomes more sensitive to certain chemicals. And when you take multiple drugs, they don’t just sit there-they interact.

Here’s how it breaks down:

• Drug-drug interactions: One medication changes how another is absorbed, broken down, or eliminated. For example, combining a blood thinner like warfarin with an anti-inflammatory like ibuprofen can cause dangerous bleeding.
• Drug-disease interactions: A drug meant for one condition can make another worse. Anticholinergic drugs (used for overactive bladder or allergies) can worsen dementia symptoms.
• Side effect stacking: Each pill has its own side effects. Take five pills, each with a 10% chance of causing dizziness, and your total risk isn’t 10%-it’s closer to 40%. That’s why falls become so common.

Studies show that people taking seven or more medications are 42% more likely to have trouble walking or balancing. One in three seniors on multiple drugs reports falling in the past year. And falls don’t just mean bruises-they mean broken hips, long hospital stays, and loss of independence.

The Real Cost: More Than Just Money

It’s not just about health-it’s about life. A 2022 Medicare survey found that 48% of people on five or more medications believed they had a side effect from one of them. Nearly 30% said they cut back on social activities because they felt too tired, dizzy, or confused.

One woman, Martha, 72, told UCI Health: “I was taking 17 pills a day. I couldn’t remember which ones I’d taken. I felt like a pharmacy on legs.”

Then there’s the cost. People taking five to nine medications spend an average of $317 a month. Those on ten or more pay over $5,200 a year. That’s more than many retirees make in Social Security. Robert, 68, said he had to choose between his heart medication and food. He’s not alone.

Non-adherence is rampant. A 2021 study found patients on ten+ medications were 3.2 times more likely to skip doses. Why? Complexity (58%), side effects (47%), and cost (65%). When you’re overwhelmed, you stop taking the pills. That’s when things get worse.

When Polypharmacy Actually Helps

Not all multiple medications are bad. Sometimes, they save lives. For someone recovering from a heart attack, taking a beta blocker, statin, aspirin, and ACE inhibitor together can cut the risk of another heart attack by 50-60%. That’s appropriate polypharmacy-carefully chosen, evidence-based, and monitored.

The problem isn’t the number. It’s the lack of review. A 2020 study showed that when doctors took time to go through every pill a patient was taking, they found at least one unnecessary or harmful medication in 70% of cases. That’s not rare. That’s the norm.

Deprescribing: The Quiet Revolution

There’s a growing movement called deprescribing-the planned, safe reduction or stopping of medications that aren’t helping or are doing more harm than good. It’s not about cutting pills just because you’re on too many. It’s about asking: “Does this still serve a purpose?”

Here’s how it works:

1. Review everything: Include prescriptions, OTC drugs, vitamins, and supplements. Many patients don’t tell their doctors about aspirin or melatonin-but those can interact dangerously.
2. Use the Beers Criteria: This is a list of medications that are risky for older adults, like benzodiazepines for sleep or NSAIDs for pain. These drugs are responsible for 45% of inappropriate prescribing in seniors.
3. Taper slowly: Don’t stop cold turkey. Withdrawal can cause rebound symptoms. A 3-6 month plan is typical.
4. Monitor closely: Watch for changes in mood, balance, sleep, or energy. If symptoms improve, you’re likely on the right track.

One patient on Reddit, described by a nurse, was taking 12 medications. After deprescribing three that weren’t needed, her dizziness and confusion vanished. She started walking again. She stopped falling.

Who’s Responsible?

It’s not just the patient’s job to manage this. Doctors, pharmacists, and insurers all play a role.

The American Society of Health-System Pharmacists says physicians should review all medications for anyone on five or more drugs. The FDA approved a tool called MedWise in 2022 that flags dangerous combinations-and it reduced high-risk pairings by 37% in early trials.

Medicare now requires medication reviews for people on eight or more drugs. But only 28% of primary care doctors say they have good systems to handle complex regimens. And only 12% of medical schools teach polypharmacy as a formal topic.

That’s the gap. We have the tools. We have the data. But we don’t have the systems.

What You Can Do Right Now

If you or a loved one is on five or more medications, here’s what to do:

• Make a complete list of everything you take, including doses and why you take them.
• Bring it to your next appointment. Ask: “Is this still necessary?”
• Ask specifically about anticholinergics, benzodiazepines, and NSAIDs. These are the most common culprits.
• Don’t be afraid to say: “I’m having side effects. Can we try reducing something?”
• Ask if a pharmacist can do a medication review. Many pharmacies offer this for free.

It’s not about taking fewer pills for the sake of it. It’s about taking only what you truly need. One woman told her doctor she felt better after stopping a cholesterol pill she’d been on for 15 years-she’d never had a heart problem. He said, “I’m glad you brought it up. I didn’t realize you were still on it.”

That’s the problem. No one’s keeping track.

The Future Is Clear

Without action, polypharmacy will cause 40% more adverse drug events and $127 billion in extra healthcare costs by 2035. But change is possible. The Choosing Wisely campaign, launched in 2021, cut inappropriate prescribing by 22% in participating clinics. That’s proof it can work.

It’s time to stop thinking of pills as solutions and start seeing them as risks. Every medication you take has a cost-financial, physical, and emotional. The goal isn’t to take less. It’s to take only what matters.

Your body isn’t a pharmacy. It’s a living system. Treat it like one.