Polypharmacy & De-Prescribing

Following on from the recent medication poll I enclose a couple of articles to consider when taking lots of different medications. 

My question is how many medications do you take and have you ever considered that any of them may be 'unnecessary' e.g. are no longer helpful or could perhaps be replaced with an alternative, possibly less invasive or damaging treatment? 

Would you consider an alternative treatment, for say, sleep hygiene rather than a sleeping pill;  counselling rather than depression meds; losing weight for high BP or a low carb diet / weight loss programme for diabetes type II or would you prefer a pill?  Were any alternative treatments suggested to you before you were prescribed your medications and has anyone ever reviewed them if you take a lot of pills? 

These articles make for good background reading perhaps?

1)  'Clinical Consequences of Polypharmacy in Elderly' is interesting and may strike a chord with many members here. (Supplements and OTC medications are mentioned).


2) A second article which exemplifies a medication review of unnecessary prescribed medications explains the practice of 'de-prescribing'.  This literally means taking a patient off a medication via tapering if necessary because it is no longer necessary or could be replaced by another treatment / drug. The case study is for a woman taking multiple meds for a common set of conditions and provides guidelines to general doctors on how to reduce polypharmacy (e.g. lots of medications).




by Gemita - 2023-04-27 06:39:02

Hello Penguin, yes polypharmacy is becoming a real problem for so many of us with multiple complex health conditions, but where and when do we stop I ask myself?  In the UK with the pressures our NHS is under, I would advise all patients to ask for an annual review (or sooner) of their medication, particularly if they are not happy with any side effects.  In my experience, reviews are not always done “automatically” and once a patient is on a med, they may remain on that med for years unless they complain of side effects or they develop another health condition as a result of one or more of their meds.

It depends so much too on the age of the patient and on the patient’s condition whether or not to treat with multiple meds that may take away their quality of life.  For example a serious inflammatory condition in the young might be best treated with multiple meds, while in the elderly patient with a poor prognosis, they may not wish to have what little quality of life they have remaining, taken from them with powerful meds that at best might only give them a few extra months.  

Personally I have got my meds down to only three (not counting supplements):  I take a daily anticoagulant, beta blocker, Proton Pump Inhibitor.  During the past few years my doctors wanted to prescribe Osteoporosis treatments, Amiodarone (antiarrhythmic) and other meds which I declined.  Both my Osteoporosis and arrhythmias have improved on minimal pharmacological treatments, so perhaps I made the right decision?

My husband has recently had a number of his meds stopped because of worsening symptoms.  He has regular reviews now and our GP and nurses are absolutely fine stopping some of his meds.  In fact, surprisingly his blood pressure has started to fall on lower doses of beta blockers now.

I will make a note of your poll question(s) for a future Poll, Penguin.  I have done a post on “Quality of Life issue” myself in the past, asking whether fewer rather than more meds are the way to go?  Thank you for raising a very important question which is close to my heart.

Driven by patients or doctors or the pharmaceutical industry

by Penguin - 2023-04-27 07:05:04

Thank you for your condsidered reply Gemita. Your husband is an interesting example if you don't mind me saying so and I personally think your own decisions are good ones.

The 'drivers' of polypharmacy are interesting to consider perhaps?  For example who drives the demand for more and more drugs? 

Is it us the patients who demand more drugs and solutions for every minor niggle and see them as a quick fix and complain if  there's no prescription offered? Anti-biotics are a prime example.

Is it doctors who reach for the prescription pad too readily ? Or do they sometimes have no choice but to prescribe due to NICE guidelines or because there are fewer community or therapy support options and long waiting lists?

Is it the pharmaceutical industry who have lowered the criteria for illness substantially enough for symptoms to qualify for meds which would previously have been ignored or would have been left untreated?

Is it bodies like the MHRA (in the UK) and FDA (in the US) who allow too many drugs through the net which have serious side effects or side effects which may not come to light (fully or at all) in the testing period because it is time limited. This particularly applies to drugs tested for say 12 weeks but which are typically taken for much longer e.g. months or years?  


Angry Sparrow

by Penguin - 2023-04-27 07:15:08

You raise some additional and very interesting points. Your case is a great example of what happens. I commend you for speaking up and checking up on interactions. Many people are not like that and will just accept and swallow the pills.  

I hadn't thought about environmental factors but there are so many people reacting to these and I personally have absolutely no idea how those factors might affect what we take.  

Food, drink, OTC meds and supplements are other things to consider, but we often don't know how many of them will react with our conditions.



by Tracey_E - 2023-04-27 08:32:49

I'm super picky about the pills I take and it irks me to have to take any at all. I regularly talk to the pharmacist to make sure nothing is interacting and be clear on what otc is safe. I don't want to end up on meds for the side effects of my meds. I'm all about natural solutions. 

Covid left me with asthma and I hate the side effects of the asthma meds but have learned that taking them religiously is really my only option. I don't see ever getting off of those. 2 prescription, 2 otc. 

I know my bp and A1C are related to my weight but working out like a fiend and eating well not only have I not lost weight, but I've steadily gained since menopause. I'm currently temporarily on diabetes meds to hopefully break the cycle, at the very least get A1C out of pre-diabetes territory. I hate meds, and do not under any circumstances want to be on these long term, but I've tried everything else and the scale won't budge so I'm giving it 6 months. If I could lose 20 pounds, I could likely be off everything else I'm on so I'm seeing it as a means to an end. 

Then there's my husband. He's on bp meds and his bp is good so stopped watching his salt intake. He's on a statin so now his cholesterol is good, so he eats what he wants. Frustrates the heck out of me, pills are not a replacement for taking care of your health. 


by IAN MC - 2023-04-27 08:56:13

Penguin asks the interesting question  " What is driving the Polypharmacy phenomenon ?" ..When you consider that, here in the UK, the number of prescriptions has increased threefold over the past 15 years, something must be changing  :-

- Patients are living longer and when they do die they have experienced a far greater range of illnesses.

- Technical advances such as pacemakers are contributing to the trend

- Drugs used to be prescribed only for individuals  who were ill.   Now the view is that whole populations are sick , so  B.P./ Cholesterol / Glucose levels in whole populations are being altered. It is now believed that more is to be gained by lowering these values in millions of people rather than concentrating on the relatively few with markedly elevated readings.

- Here in the UK , GPs are financially  incentivised for reaching a whole range of health targets. Did you know that every time your GP says " While you're here I will take your Blood Pressure" this is increasing his earnings. Every time your GP carries out a health check he is paid an extra £24.......... drug prescriptions are often a side-effect of the whole process.

- The pharmaceutical industry can now increase its market to include the healthy as well as the sick. Mass-medication is the name of the game and it's here to stay.

I spent most of my working life in the pharmaceutical industry .

Polypharmacy doesn't half help my pension so it's not all  bad news !



by Penguin - 2023-04-27 09:26:28

I did know about GP incentives.

I agree about pacemakers contributing to the trend too. They are a treatment afterall. A manufacturers Rep told me that clinicians (the customer in the Uk) are driving the demand for new technology which will tackles an increasing range of issues with algorithms for this, that and the other.  I'd like the emphasis to be on the patient ideally and what they want and improving algorithms for common issues rather than widening the net. 

I also agree about targetting the 'well'.  How often do you hear 'we all have mental health' as a statement trotted out by celebrities, on social media and TV these days? My answer: Yes, but that doesn't mean that we all have mental ill health and need treatment for it . Everyone seems to have 'anxiety' these days and Covid has encouraged a whole new potential customer base it seems. Mental health symptoms have more potential than other illness groups for marketeers as Mental ill health can be gleaned from how 'we feel' and can't be quantified via blood tests or scans which provide a tangible result. 

Re: yr pension. I think I have some unethical pension investments too, so I'll forgive you Ian!!

Take a look at this de-prescribing initiative video. I don't think it will trouble the pension too much, but a worthwhile CPD training initiative I think. www.deprescribing.org



by Penguin - 2023-04-27 09:46:35

I can relate to the weight gain. Mine has crept up too over Covid and since.  It gets harder to shift doesn't it ?  Hats off to you re: working out - you are doing an amazing job! Diabetes is a worry. 

Asthma meds are another thing that are given out like smarties over here to our children. One of mine was offered an inhaler as a child during a continuous bout of some coughing / spluttering / sinus infection or other that went on and on.  He didn't have asthma. Asthma following Covid is another thing altogether. That must impact on your training / fitness?

Statins are an interesting one and that whole concept of unhealthy / healthy cholesterol. I don't and won't take them.   They've been rolled out over here as a preventative measure.  

I agree with preventative medicine - vaccines for example - but statins have so many potential side effects. 


by Tracey_E - 2023-04-27 10:56:08

As long as I keep my allergies under control and take the controller asthma meds, it does not impact my workouts at all. I do albuterol before every workout and I'm good to go. I hatehatehate knowing I'll be on these things forever but I also like breathing without coughing and chest pain so it is what it is. As least the meds get me to close to 100%. 

A cough can be a symptom of asthma. I've never been left gasping for breath, it's always a wheezy cough, or chest or upper back pain. Albuterol just open up the airways with no lasting effects so imo not inappropriate to offer for short term relief. 

I'm not on a statin either but my gp, cardio, ep, and cousin who is a gp all take them as a preventative. All 4 are ideal bmi, work out a lot, and as far as I know do not have any indications of heart disease, yet they all choose to take it. Gp and ep both offered it to me but didn't push when I said no thanks. 

Polypharmacy phenomenon

by docklock - 2023-04-27 11:03:50

I admit I had to "Google" what the term meant and from what I gathered it's taking a specific drug and then taking others to counteract the 'side effects' of the original drug.  And then taking more and more drugs to counter side effects of more drugs.

I take four prescribed drugs -- two for BP and pulse, one for diabetes type 2 and the last for cholesteral. All are generic and have been used for a long time for specific issues.

My suspicious nature tells me that Big Pharma has a great interest in coming to market with "new" wonder drugs -- at a huge price and mark up.  Generally, if it's advertised on TV, it's beyond my price range.

Many of the wonder drugs are simply a combo of a couple of 'older' versions combined into a 'new' pill. One in particular is advertised to lower A1C, however (to me) if I lower my gluose to 110 or so, I'm also lowering my A1C.  

I also think that a lot of 'older people' trust their Doctor without question and accept what they say as gospel --- I DON'T and I question everything they tell me. 

I swear Big Pharma 'invents' a 'new drug' and then finds a illness/disease to "cure it."

No, not a chance in H, E, double hockey-sticks

by AgentX86 - 2023-04-27 11:12:19

Eight drugs (+1 antibiotic for the next 10 days) and four suppliments (all prescribed by doctors).  Most (5) of the drugs are common heart-related so there is a lot of data WRT interactions and side-effects. The ones that aren't are for gout (no, I'm not about to go through another attack to test someone's new theory), siezures (not going there either), and glaucoma (blindness doesn't sound fun either). My brother tried to get his cholesterol under control using diet.  He had a SCA. Anecdote, sure, but drugs do bring down chloresterol (though there is argument on either side of its importance).

There are too many charlatans hawking whatever, to whomever, will listen to their speel.  Too many diet books written by no-nothings with wild theories just to make a buck off unsuspecting fools (and then turn around next year with a completely different one).

An easily refutable example that keep coming around that people keep falling for is the amount of crud built up in the colon. Getting rid by, whatever is selling this week, will decrease weight by 8-24 pounds.  Utter nonsense.  8 pounds is a gallon, 24 pounds is about (perhaps low end) what an expectant mother gains when pregnant.  Does anyone think they can hide that much weight in their intestines?

Pharma certainly is far from perfect but

- you know what you're getting

- has been tested (though one isn't sure after the covid nonsense) for eficacy

- inspected for purity

- interaction data

- Well known side-effects

Who knows what you're being sold under-the-counter by purveyors of snake oil (though the FDA can't be trusted anymore).

Prescriptions for prophylactic drugs is another point.  My eye pressure is in the low-normal range but I show signs of glaucoma anyway, so my eye pressure needs to be even lower. Bring in another (expensive) drug. I don't know if you'd call cholesterol drugs prophylactic but after one bypass, I'll take my chances with it.

under control using diet.  He had a SCA. Anecdote, sure, but drugs do bring down chloresterol (though there is argument on either side of its importance).

There are too many charlatans hawking whatever, to whomever, will listen to their speel.  Too many diet books written by no-nothings with wild theories just to make a buck off unsuspecting fools (and then turn around next year with a completely different one).

An easily refutable example that keep coming around that people keep falling for is the amount of crud built up in the colon. Getting rid by, whatever is selling this week, will decrease weight by 8-24 pounds.  Utter nonsense.  8 pounds is a gallon, 24 pounds is about (perhaps low end) what an expectant mother gains when pregnant.  Does anyone think they can hide that much weight in their intestines?

Pharma certainly is far from perfect but

- you know what you're getting

- has been tested (though one isn't sure after the covid nonsense) for eficacy

- inspected for purity

- interaction data

- Well known side-effects

Who knows what you're being sold under-the-counter by purveyors of snake oil (though the FDA can't be trusted anymore).

Prescriptions for prophylactic drugs is another point.  My eye pressure is in the low-normal range but I show signs of glaucoma anyway, so my eye pressure needs to be even lower. Bring in another (expensive) drug. I don't know if you'd call cholesterol drugs prophylactic but after one bypass, I'll take my chances with it.

drugs prophylactic but after one bypass, I'll take my chances with it.

Edit: Deleted copy

GP payment

by Selwyn - 2023-04-27 11:30:48

Ian MC has the wrong end of the stick when it comes to GP payments. Without meeting threshold responses GPs are penalised in their pay.  Yes, for example,  we will pay you £70 000  per year, however if you don't do this that and the other, your pay will be reduced accordingly!

Can you imagine teachers having to get paid if their class only reaches an examination pass rate of 80%. So, if you have 79% examinaitons success, you don't get paid!  This is the situation GPs find themselves in  - yes, IF YOU REACH YOUR THRESHOLD TARGET your BP measurement may be worth some money to your GP, as may the absolute value for hypertension control. There is no other professional group so dependent on performance across a population. 

In the last 8 years 1200  GP practices have closed in Britain. GPs are under enormous strain. Numbers willing to work in such a way are declining. The result is primary care strain has increased ( see https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis ), yet compared to hospital care, GP care is very cost effective, and has been underfunded for years compared to hospital medicince.

Your practice does have target payments for pharmacy review of your medications. You should be contacted accordingly. I am contacted by my practice pharmacist. Thank you.

Structured Medicine Reviews (SMRs) are an evidence-based and comprehensive review of a patient’s medication, taking into consideration all aspects of their health.  In a structured medication review clinicians and patients work as equal partners to understand the balance between the benefits and risks of and alternatives of taking medicines. The shared decision-making conversation being led by the patient’s individual needs, preferences and circumstances.

Problematic polypharmacy is where, for an individual taking multiple medicines, the potential for harm outweighs any benefits from the medicines and/or they do not fully understand the implications of the medication regime they are taking. This includes:

medicines that are no longer clinically indicated or appropriate or optimised for that person, combination of multiple medicines has the potential to, or is actually causing harm to the person - practicalities of using the medicines become unmanageable or are causing harm or distress.
SMRs have benefits to people taking multiple medicines:

Improved experience and quality of care through being involved in the decision-making process and having a better understanding of the medicines they take less risk of harm from medicines (e.g. adverse drug events, side effects, hospitalisation or addiction), better value for local health systems (e.g. reduced medicine waste).

Thank you to British general practice!  What a shame Government and some members of our community do not understand what is happening in real life. 

Selwyn / Docklock

by Penguin - 2023-04-27 19:13:19

Thank you for clarifying some misunderstandings. Arrangements between the government and medicine are cloaked in mystery.  Certain aspects perhaps get misconstrued a little. 

For the record I think GPs do an incredibly difficult job too and we all recognise the pressure they are under from workload. The stress radiates down from that unfortunately and we're all affected as they are the gatekeepers in our healthcare system.   

It is however, disconcerting to think of them receiving what amounts to performance related pay. I didn't understand the arrangements that you describe and I agree that it seems inappropriate to set targets related to a patient's health outcomes when there are so many variables outside a GPs control like a patient's lifestyle choices.

My GP surgery offers medication reviews. I've seen them advertised on their noticeboar although I'm not in the polypharmacy bracket.  As Angry Sparrow describes, many hospital admissions for various health conditions can result in new drugs everytime that a vulnerable patient is admitted and polypharmacy results.

Re: Monitoring - blood tests happen but often seem to prompt modification of doses and sometimes new drugs but not necessarily a complete review / overhaul of polypharmacy. 

The huge increase in prescriptions is testament to what Ian suggests - a society which is (in certain sectors and many new sectors) becoming over-medicated.  It's a recognised issue and to their credit, medicine seem to be acting on it and taking it seriously - finally!  I raised this thread because it's a big problem in an aging population and a lot of people on this forum fall into that sector.

I don't have any prescribed meds currently and haven't had for years although I do have a pacemaker. My meds were stopped years ago and have never been re-started or suggested. However, I no longer get called in for routine blood tests. This is because meds rather than a cardiac condition / pacemaker are the trigger for monitoring. Despite this pacing can have effects on the body and those effects may be picked up in the blood. I have asked for annual testing since.

Doclock - The 2nd article I enclosed explains what polypharmacy is and explains how deprescribing should ideally happen. It mentions the shared decision making process in Selwyns comment. I appreciate that not everyone reads links.  

Re: Over prescribing - The recent cris with pain meds is an example of what can go wrong when drugs are over-prescribed particularly with meds which were intended for short term use.  Referring to this as 'addiction' is to my mind, unfair and inaccurate when dependency is created via medical advice to take a substance for longer than it is wise. In truth it's not easy to stop these drugs once they have been prescribed for too long and harms are clear.  The emphasis has been on the patient being unable to stop craving the drug and demanding it, whilst the underlying prescribing practices are surely the more important issue to address if we are to uncover cause?

Re: De-prescribing - This isn't always straightforward. Re-bound effects, withdrawal syndromes, dependency are not always as well documented as they could be and the risks aren't necessarily laid out as well as they could be. Expert advice when dependency occurs is patchy. Doctors are bound by NICE protocols which aren't necessarily as cautious as necessary in some cases.   Careful de-prescribing, knowledge led tapering protocols and ensuring that the drug isn't over prescribed in the first place is surely best practice?

Cardiac drugs are not exempt from de-prescribing issues and older patients are far more vulnerable. We need to treat this group of patients and other patients reliant on drugs that are difficult to stop with caution, with respect for their wishes and to help everyone understand the risk vs benefits of treatments they engage with. 

 (Rant over!) 

Tracey-E, Agent X, Docklock

by Penguin - 2023-04-28 03:57:48

Re: Your choices. I fully understand why you have to take those drugs and why they help you. This thread isn't anti-medication in intent - it's pro the right medication in the right amounts and with informed choice.  

I don't understand the statin choices that your friends/relatives have made, but again it's personal choice and they will have their reasons.

Agent X - You clearly have reasons for each of your drugs and understand why they're prescribed and don't want to stop them despite exceeding the 9 drug marker. I think that shared decision making is one of the best ways to conduct conversations surrounding polypharmacy. It's respectful and considers your point of view. It's also up to you to decide if you want that conversation in the first place.

DockLock - We have a different system over here and don't see the advertising of drugs on TV. Any advertising is directed at doctors / the health service via 'trade' advertising. We have our drugs explained by the prescriber and often may not know anything about what's on offer until we start the conversation.  We skip the marketing speel and in some ways that's better because we receive what should be an analysis of our symptoms and a drug which the prescriber should explain in terms of risk vs benefit.

Our health system can mean that we sometimes struggle to obtain the new 'wonder' drugs as budgets for our health service are controlled centrally.  We often have no idea what they cost and what may be out there because, as patients, we're out of the loop unless we conduct our own research. 

I've also read about the re-branding of old drugs as new drugs. 


by AgentX86 - 2023-04-28 15:47:22

Direct-to-consumer advertising is a complicated issue.  I believe only Nes Zealand and the US allow it.  Here, it seems, that it's a matter of free speech (not sure I buy that argument). As long as it's not untruthful and hide risks, it's legal.  Many argue that it shouldn't be but... At pne time it wasn't.

For those of you who haven't had the joy of watching these commercials this leads to some pretty funny wording.  Of course the drugs are FDA approved so as long as the "promises" fall within that umbrella, the drug pushe, company is OK.  Eliquis ads will say something like "for those with atrial fibrillation not caused by valvular disease".  Then they find the person who can read the fastest and go down a list of contraindications, not the least of which is "do not take this drug if you're allergic to this drug" (Duh!).  "This is not a toy." has to be printed on plastic bags and "not for internal use" on household cleaners, so it might not be that silly.

Agent X

by Penguin - 2023-04-28 16:14:48

'The person who can read the fastest' made me laugh! They must be long ads! 

As for the other silly things that people may do with household cleaners:

Following Trump's seeming endorsement of bleach as a treatment for Covid 19, do your bleach bottles have to have a warning too?  


by Gemita - 2023-04-28 18:09:36

Who drives the demand for more meds?  In my experience it has been our GP, our hospital Consultants and Emergency doctors particularly for Michael since he is well known to A&E.  His meds are often reviewed and unfortunately increased in A&E.  

Antibiotics are very important for Michael and we have rescue packs at home for some of his chronic conditions like COPD and UTIs (the latter due stricture disease).  Without timely treatment, he could get into trouble very quickly.  I have learnt to spot the signs, particularly for serious infections, like Sepsis, for which he has been hospitalised on several occasions and treated with IV antibiotics/surgical treatments..  

However, neither of us seeks medication help for certain debilitating symptoms like confirmed overactive bladder, which would have many running for assistance!  In fact, whenever we attend hospital appointments, our consultants in cardiology, respiratory, endocrinology, rheumatology, urology, gastroenterology, neurology usually remark on the limited number of meds we are on and what additional meds could help. Even so, Michael is still taking 13 prescribed meds at last count although dosages have been reduced in some instances.

In fairness, our GP usually tries to support us as best he can by referring us on to specialist teams, for example the Long Term Conditions Team - Community Specialist Diabetes Clinician, where we might receive dietary advice in addition to advice on medication like insulin. 

I recall when I was first diagnosed with Osteoporosis of the spine, my GP wanted to immediately prescribe a long term medication.  I asked for time to consider all my options, including a referral for a second opinion which he happily agreed to.  I was referred to a Rheumatologist who suggested lifestyle/dietary changes alone might help.  Recent bone scans have revealed that my spinal Osteoporosis has improved and I now have Osteopenia in that area again.  I wasn’t aware that Osteoporosis could improve or be reversed, so this is just one example where self help measures could be tried first.

ads and improvements

by new to pace.... - 2023-04-28 20:38:10

AgentX86 is right about those ads, I have been listening to those ads on  the US tv, after they mention the drug and for what it should be used for.  Then they do say, if you are allergic to what ever the main indegredent  is you should not take( i ioften wonder how we would know?),  Then they speak really fast all the side effects.  At that point wonder why anyone would take that perticular drug.  I have closed captioning on my tv and it cannot keep up when they race the side effects.

Gemita glad to hear you have improved your Osteoporis.

new to pace 

Gemita / New to Pace

by Penguin - 2023-04-29 04:26:28

Re: Antibiotics. If you need them you need them!

Re: A&E and dose increases. That's been my experience with emergency care too. It's difficult in an emergency. We want some action / help and I suppose increasing meds is a solution.  The problem is that the emergency passes and the dose remains high. It's hard to know whether the symptom is temporary or worsening or exacerbated by something else which is acutely affecting you? My concern has always been whether a higher dose is merited long term.  You can't blame A&E for trying to sort it out on the spot but a review after the crisis has passed can help.  

My GP (years ago) was really good with this kind of thing. I remember coming out of hospital with a med that was producing difficult side effects which my consultant insisted I should persist through.  My GP instantly told me to put it aside to the consultant's consternation. I was then prescribed something else based on a test which she described as 'hardly gold standard' and she spotted the very obvious side effects from simply meeting me in a corridor. I was referred for a 2nd opinion and that got stopped too.  

A good GP can be a great ally but once GPs are too busy to form therapeutic relationships with patients and spend the necessary time with them, it all begins to slide. 

Re: Osteoporosis - Was it confirmed or was it Osteopenia that was expected to progress? I wonder if the bar for Osteoporosis meds is set lower because progression is expected. Again though, it's personal choice - a preventative course of action or preferring to wait and see if you can prevent progression via other means? 

New to Pace 

Re: Allergies. If you have sensitivities to meds and / or allergies it must be very tricky. The ingredient lists are full of long lists of substance names that most of us have never heard of. Not everyone reads multisyllabic words well either!  You have a point about 'how do you know?'  Ingredient checking must make shopping and medical visits very time consuming. Does your doctor guide you?


by piglet22 - 2023-04-29 07:13:20

My GP surgery has largely given up medication reviews.

It used to be an annual ritual which may or may not have involved the GP or a healthcare assistant. It largely went through on the nod and frankly was a nuisance if you ran out of repeats.

The chances are that neither really knew the full history or probably only vaguely remembered you. Certainly, in my surgery, I've seen it expand to dozens of GPs scattered around five different sites, from a surgery with a couple of GPs and a nurse.

About four years ago, there was an over-ambitious plan to build a super surgery, but Covid put paid to that. Unfortunately, the damage of partly amalgamating four surgeries into one had been done.

Part of this ambitious plan was to employ a surgery full time pharmacist who I saw once about four years ago. Nothing changed as a result and that service, like others, Well Man Clinic etc., have all been ditched.

The long and short of it is that they simply don't have the time to do full reviews so you get left on old, inappropriate medications for decades until something goes wrong.


by Penguin - 2023-04-29 07:35:16

I suppose that for a medication review to be used effectively, both parties need to see a need for it and want to look into what can be done to make matters better or prevent ADRs (Adverse Drug Reactions) or interactions.  If you see a review as a nuisance which then prevents you from getting certain prescriptions or delaying them, you're not going to want to have them. 

I remember reading your recent post about a beta blocker (Atenolol ??) which you've now run into problems with and which had been prescribed for years at high doses  Was it ever selected as a drug to look into when you were offered reviews?  

I think it can be more concerning if a doctor wants to change a drug after years of taking it. It helps to understand why you've been on it so long at such a high dose and why that's no longer deemed appropriate.  The de-prescribing method matters too with beta blockers especially if you encounter problematic or unexpected symptoms.  Knowing they might occur and what to look out for needs to feature in the discussion. 

Following this experience Piglet would you be more willing to attend medication reviews if your practice started offering them again? 



by new to pace.... - 2023-04-29 09:00:39

Penguin no  some my doctors do not listen to me say the side effect will not make me better.  This last time I went to the GP for what i found out was an in ground hair in my lower lid of my eye.  Prescriped an eye dop i said i think i cannot take this.  Sure enough found out i was right.  Stopped and sent an email though the patient portal.  She then wrote back and said should they put it in my chart.  I of course said please do.  I then healed it by putting the occasional  hot water soaked wash cloth on often during the day.  Esp. now when i take hot showers.

new to pace

New to Pace - notes / Chart

by Penguin - 2023-04-29 10:54:39

I'm pleased the hot cloth treatment worked. Nice simple solution to try first. 

I always feel a bit daft when I refuse a treatment and then get told that there won't be any problem. I often end up taking the treatment with misgivings. Sometimes I'm right and sometimes I'm not. I think doctors can be a bit blase about ADRs unless they're really serious. 

This won't apply to your sensitivities, but there's a black triangle that appears on drugs still awaiting feedback from doctors / patients. Usually they're drugs which are new to the market and although they've been tested in lab conditions / trials more information re: side effects, effectiveness, tolerability etc is gained once the drug is released for sale.  The black triangle invites feedback once the drug is in circulation. 

Lots of doctors are apparently too busy to report back.  I don't doubt this, but it would really help! I report any side effects I get, but I don't know how many patients do so? 

It would be helpful to have a database that reflects these things better - particularly for new drugs. 

DXA bone scan results

by Gemita - 2023-04-29 14:11:19

Yes Michael certainly needs antibiotics but taking them so frequently does cause bacterial resistance.  Some of the common antibiotics which would be kinder to him are often ineffective now, so instead of one antibiotic, he would need two or more to get on top of any infection. 

Like Piglet, we find there is little “continuity of care” these days, at least not at our GP practice.  Gone are the days when we saw the same GP.  Most of the GPs we see nowadays are locums and we seem to see a new face each time we visit our surgery.  I know from speaking to my neighbours, they feel the same.  Personally and I know this might seem unkind to caring, hard working GPs and there are still many of them out there, I wish I could dispense with the GP altogether and have contact directly with our hospital consultants. It would certainly save time and money.  I have kept records going back years and liaise directly already with many of our consultants.  Indeed my husband’s consultants encourage me to do so, especially since I am the main carer for Michael and know his conditions so well.  Additionally I am doing lots of home monitoring like BP/heart rate checks, glucose checks and keeping a record of these and of any symptoms).

Yes Penguin, Osteoporosis was confirmed in my spine in 2019 following an Oryon Imaging DXA bone scan.  Osteopenia was confirmed in both hips. These results were based on the WHO Classification for Osteoporosis.  They were also confirmed by a Rheumatologist.  A Bone density scan in 2022 however confirmed I had Osteopenia in both the spine and the hip.  In both cases, improvements had been noted, although clearly my fracture risk is still fairly high so I may need to re-visit treatment options


by AgentX86 - 2023-04-29 23:16:29

I had no idea how I did it but several years ago fractured my pelvis.  I didn't fall or anything but there it was.  The orthospedist sent me for a DEXA, which revealed osteopenia and I was referred to an endicrinologist. Osteopenia was tracked down to a thyroid problem, which was in turn blamed on ameoderone.  I stopped ameoderone (I think I already had) and everything went back to normal. The endicrinologist prescribed 5000u vitamin-D.  After everything went back to normal, she told me to continue on 3000u.

Pharmacisits, theoretically, are supposed to check prescriptions for possible interactions.  It's one reason it requires so much time to become a pharmacist (undergrad + four years = Pharm.D). They now have software (AI?) to check for interactions.  It's supposed to flag them but I've never had a drug flagged.  The assistant, a glorified checker, does ask if I have any questions for the pharmacist. Have had them give me warnings but not often.



One Size Does Not Fit All

by Marybird - 2023-04-30 13:26:00

Interesting thread and comments about polypharmacy, drug reviews and " depolypharmacising. I've read the linked articles as well as other articles on the topic. I see the general idea seems to be to separate seniors from their prescribed meds based on the very real assumption that taking too many, in too high dosages is harmful, both from the quantity, side effects and interactions from these drugs. In other words, causing more harm than good. And the worst thing is, according to the comments, is that all this is happening under no one's watchful eye as physicians heap prescriptions on the unsuspecting, and no one is monitoring said unsuspecting patients for adverse reactions to the meds. A potentially dire scenario indeed. 

Like so many seniors, I guess I would also meet the criteria for "polypharmacy", depending on the number of prescribed meds put forward in the definition. I've seen numbers between 5 and 10 prescriptions in the literature, I have 7, so I guess that puts me smack in the middle. Gee, I should be worried!

But in reviewing the articles on the topic, I see  drugs high on the on the culprit list are those prescribed for anxiety, depression, sleep deprivation, pain relief, seizure prevention, although diabetic medications also make the list. I'm happy to report that I do not, and have never taken any of those drugs, I have no need to do so. I'm not diabetic, not depressed, anxious, don't have gout or a seizure disorder, and with any luck I can keep Alzheimer's disease or other dementia at bay through lifestyle practices, mindful living. 

The drugs I take are for control of my hereditary hard to control blood pressure, as well as for control of longstanding tachycardia/atrial arrhythmias. They do a great job, along with regular exercise and diet to keeping these under control, and I have taken the combination for so long any side effects I may have experienced during the beginning are history. I've had occasion to experience what cutting back or doing without these meds is like, and it ain't pretty, with uncontrolled blood pressure, increasing arrhythmias and tachycardia, including A-fib, with rates going up as high as a bit over 200.

But the drugs, a combination of relatively low doses of losartan hcl ( 50mg), chlorthalidone ( 25 mg), work well for the blood pressure, along with metoprolol tartrate ( 150mg/day- increased to this dose a couple years ago to help the A-fib) and diltiazem ER ( 360mg/day) for both blood pressure and heart rate control- helps with breakthrough A-fib. They're all low cost generic, don't think my cardiologist, who prescribes all these drugs, is making any kickback profit from them. He's also prescribed Eliquis, as a stroke preventative ( my CHADS2 score is 4) when my pacemaker monitor reporrs started picking up increasing episodes of A-fib., I've seen a number of my family members suffer debilitating strokes and don't want to go there, so I will take the Eliquis, which far as I can tell has caused no untowards problems with me. 

I also take a low dose statin- simvastatin at the insistence of my PCP, I've debated its merits but also observe the climb in my lipids when I don't take it( even with diet) so don't argue much about it. 

Like Agent, I've also received a diagnosis of glaucoma, with increased intraocular pressure and changes associated with glaucoma. The eyedrops ( I was able to switch to a generic prostaglandin medication which was much less expensive) seem to be doing a good job at keeping things under control. I'm not about to trade potential blindness with a "yeay, one less med for me" jump on the no meds bandwagon. 

As for review of my medication list, this is done at each visit to my PCP and to the specialists ( cardiologist, opthalmologist)  who prescribe the meds. I'm always afforded an opportunity to ask questions or express concerns about the meds. Any concerns have always been addressed, and these practitioners always emphasize the importance of life style, ie, regular exercise, diet, and stress reduction as much as possible to keeping things as well as they can be. I also have basic metabolic panels, lipid, and liver enzymes checked twice a year by my PCP, as a way of checking for issues that might be caused by the meds. 


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