9 reasons to review medications every year

Have a health issue? Chances are, there’s a pill for that. And that’s good news. Modern medications can help control the chronic conditions that often come with getting older. 

But there’s a downside, too: Something called “polypharmacy,” which means “many medicines.” Close to 67% of adults between the ages of 62 and 85 use at least five prescription and over-the-counter medications a day, according to a recent study in JAMA Internal Medicine. 

On top of that, many people are adding over-the-counter medications as well as dietary supplements to the mix. That’s a whole lot of pills, and if you’re not careful, it can lead to a whole lot of trouble. 

“This is one of the major issues for older adults,” says Sharon Brangman, M.D., head of geriatrics at Upstate Medical University. “As we get older, we tend to experience more medical problems, so it makes sense that our medications increase, too.” 

But sometimes, the reliance on medications can cause health issues. 

“After a while, people may be taking so many pills that they start interacting with one another, and pretty soon it looks like you have a new disease,” Dr. Brangman says. “Then your doctor prescribes you another pill for the side effects from the original pills. It all adds up, and you can find yourself in this endless loop. I have some patients who start their day off taking nine pills. By the time they’re done, they have no appetite for breakfast.” 

If your medicine cabinet is overflowing, you may be facing some serious health concerns. Your risk of falling grows by 7% with each medication you add, according to a report in the journal BMC Geriatrics. And the risk for cognitive issues such as delirium or even dementia increases, too, says Dr. Brangman.

One thing’s for sure: Taking medications safely is important. Your annual wellness visit may be a great place to start.

“That’s a good time to sit down with your doctor and review your diagnoses and all your medications,” says Dr. Brangman. At this visit you can: 

• Clarify why you’re taking each medicine  
  
• Ask how best to take it (with food or without, for example, or at a specific time of day) 
  
• Learn which side effects to expect and how to handle them 
  
• Share concerns you may have about your medication routine
• Discuss any lower-cost alternative options that may be available 

“An annual review is the bare minimum,” says Dr. Brangman. “If you’re seeing your doctor a few times a year, be sure to review your medications at each visit. And never make any changes without talking with your doctor or pharmacist first.” 

Here’s a closer look at 9 ways a yearly medication review can help you take charge of your health. 

Polypharmacy may lead to extra provider visits, more hospital admissions, and a roughly 30% percent increase in medical costs, according to researchers at Duquesne University’s Mylan School of Pharmacy. With a medication review, you can keep an eye on your prescription expenses and possibly discover ways to save. For example, you can ask your provider about switching to a generic or a less-expensive medication. 

From an allergic reaction to dizzy spells to an accidental overdose, adults over the age of 65 are nearly 7 times more likely than younger people to be hospitalized due to an adverse drug event — or ADE — according to the Centers for Disease Control and Prevention.

Taking 5 or more medications? Your risk of an ADE is 88% higher than somebody taking fewer, according to the findings of an 11-year review of ADE-related health care visits from the National Center for Health Statistics. The study’s authors also found that older adults are at the highest risk of hospitalization after an ADE.  

At a medication review, ask about all the possible side effects you might encounter — and what steps you can take to prevent and/or manage them, says Dr. Brangman. Remember, you don’t want to just stop taking a medication because of a side effect. Call your provider for their advice.

The more prescription and over-the-counter medications a person takes, the greater the chance of interactions, says Dr. Brangman. Research in the Annals of Pharmacotherapy, for example, shows that patients over the age of 65 who take between 5 and 9 medications have a 50% probability of an interaction. That went up to 100% with 20 or more medications. 

Many drug interactions are not serious, but a few are, she says. Two otherwise safe medications taken together may cause dangerous sedation, for example, or may lead to irregular heart rhythms or raise blood pressure. Some drugs can block the absorption of another medication, leading to toxic levels of a drug building up in your bloodstream.

Others may change the effects of different medications. For example, certain cholesterol-lowering statins may increase the blood-thinning effects of warfarin, which could increase your risk of bleeding.

Your primary care provider is in a good position to keep tabs on medications that are being prescribed by different specialists, or after a procedure or hospital stay, says Dr. Brangman. Your pharmacist should also be keeping an eye on this, which is why it’s ideal to find a pharmacy you like and stay loyal.  

Some patients may see a specialist — or multiple specialists —more than they do their primary care provider, says Dr. Brangman. Or they could be using more than one pharmacy.  

“That means there’s nobody keeping an eye on the big picture,” she says. She says she’s seen patients who’ve wound up taking two prescriptions for the same drug, each with a different name.  

“A medication review can easily catch and correct problems like that,” she says, adding that limiting yourself to one pharmacy is another safety measure that can help cut down on medication mistakes.

If your medication regimen is complicated, you may not be sticking with it. Only 35% of patients on 4 or more medications correctly follow the plan their provider gave them, according to a large review of studies on polypharmacy and older adults that was reported in the journal Drugs & Aging. 

“Some regimens can be really challenging,” says Dr. Brangman. “Some pills you take on an empty stomach, some after eating, some at bedtime. It’s easy to get confused. A medication review can help you organize a system that’s easier to follow.”

The key, of course, is that you let your provider and/or pharmacist know that you’re having trouble taking your medications as prescribed. 

You may also benefit from simplifying your refills. Depending on the Medicare Advantage plan and the medication you’re taking, you may be able to get a 3-month supply of maintenance medications at a network retail or home-delivery pharmacy.

Maybe you’ve dropped some pounds or added some exercise. As a result, your provider may recommend that you move to a lower dose or a different class of medication. Some lifestyle changes may also mean you no longer need to take certain medications. 

“Whenever you reach a goal like weight loss, it’s time to reevaluate your medications with your provider,” says Dr. Brangman. 

Just remember to not make any changes to your medications without checking in with your provider first.

“Adults aren’t one-size-fits-all,” says Dr. Brangman. “Some patients may be 90 years old and weigh 90 pounds and take the same dose as a football player — it doesn’t make any sense. As you get older, your kidneys slow down and your liver doesn’t break down drugs as efficiently.” Your annual review is the perfect time for your provider to make needed adjustments.

It’s common to be prescribed new medications after dental procedures, minor injuries or hospital stays. A medication review can help determine whether you still need them.

Do you take vitamins, supplements and over-the-counter pain relievers? “Those are medications, too, and some — especially herbal supplements — can interact with your prescriptions. That can be potentially harmful,” says Dr. Brangman.  

Be sure to tell your provider and pharmacist about everything you take. Even better, bring the supplement bottle with you to your review, so your provider can take a closer look at the label and ingredients list.