Deepina Pal, 26, has suffered from chronic kidney disease since she was 16 and has been on dialysis for nine years. She takes about 10 to 12 different medications every day for a variety of autoimmune and other chronic diseases, including medications for blood pressure, cholesterol, thyroid and heart disease, as well as migraines and other problems. Some need to be taken three times a day.
She sets alarms and records her medications on her phone. When she was first prescribed blood pressure medication, she became very drowsy and slept for long periods of time. Her family later realized her blood pressure was falling. For people on dialysis, regular blood tests may lead to changes in treatment regimen.
Dipina’s experience highlights an important factor when it comes to taking multiple medications: the amount of medication alone does not mean that treatment is inappropriate. The question of safety is whether each drug remains necessary, effective, and appropriate as a person’s health changes.
Multiple conditions, multiple medications
Polypharmacy is commonly referred to as the regular use of five or more medications; using 10 or more is often called hyperpolypharmacy. This is especially common among older adults living with multiple chronic conditions, although complex treatment regimens can be used at any age.
A review of 27 studies involving 11,649 older adults in India found the pooled rates of polypharmacy and hyperpolypharmacy to be 49% and 31%, respectively.
“Not every case of polypharmacy is inappropriate,” says S. Manika Saravanan, consultant, geriatric medicine, Apollo Hospitals, Grims Road, Chennai. For example, a person living with diabetes, hypertension, and cardiovascular disease may require multiple medications. Concern arises only when medications no longer provide clear benefit, are duplicative, interact negatively, or create a treatment burden that outweighs their benefit.
The World Health Organization identifies drug safety for polypharmacy as one of the priorities of its Medicines Without Harm initiative.
Risks
Smita Jain, consultant, internal medicine, SIMS Hospital, Chennai, says problems can arise when medications prescribed by different specialists are considered separately and not as one treatment plan.
A patient may accidentally receive duplicate medications, especially if multiple doctors prescribe them for different conditions. Combinations of drugs can also cause harm. Some medications used for heart failure or blood pressure may affect potassium and kidney function; antifungals may interact with antiepileptic drugs, and some combinations may increase blood thinning levels and the risk of bleeding.
Taking an extra dose can also be dangerous. Taking extra diabetes medications can cause hypoglycemia, and missing certain medications, such as antiepileptic drugs, can trigger seizures.
Older people are especially vulnerable because age-related changes, kidney or liver problems, frailty, cognitive problems and multiple medical conditions can change how the body processes medications. Side effects such as low blood pressure, low sodium levels, dizziness, and confusion may increase the risk of falls.
Review and Security Checks
“A medication review should include why each medication was started, whether it is still needed, whether the dosage is still appropriate, and whether there are any side effects or interactions,” says Dr. Saravanan. Kidney and liver function, nutrition, cognitive function, mobility, risk of falls, cost, and difficulty swallowing or difficult timing should also be considered.
Doctors encourage patients to bring all of their medications to their appointments; Brown bag checking can reveal duplicate prescriptions as well as over-the-counter, herbal or alternative products that doctors may not be aware of.
An updated list of medications should be provided to specialists, especially after hospitalization or a change in treatment. Pharmacists can also help identify interactions and dosage problems. Pill organizers and alarms can reduce the number of missed or repeated doses.
Some medications may eventually be reduced or stopped when the benefits no longer outweigh the risks. This process, known as deprescribing, should be done carefully rather than abruptly stopping the medication. Electronic prescribing systems may flag some interactions and duplicate medications, but clinical judgment remains most important.
The goal is not simply to reduce the number of drugs, but to ensure that each drug has a clear purpose and that the overall treatment remains safe as the patient’s circumstances change.
Published – September 17, 2026 12:53 pm EST.
