Polypharmacy and Side Effects: How Taking Too Many Medications Increases Health Risks

When you’re taking five or more medications every day, it’s not just a routine-it’s a ticking time bomb. For millions of older adults in the U.S., polypharmacy isn’t a medical term-it’s daily life. But what starts as a way to manage diabetes, high blood pressure, arthritis, and heart disease can quickly turn into a dangerous mix of side effects, confusion, falls, and even death. The problem isn’t the medications themselves. It’s the polypharmacy-the unchecked pile-up of pills that no one ever sat down to review.

What Exactly Is Polypharmacy?

Polypharmacy means taking five or more medications at the same time. That’s the clinical threshold, but the real issue isn’t the number-it’s whether each one still makes sense. Some people need multiple drugs. A heart attack survivor might need a beta blocker, statin, aspirin, and ACE inhibitor-all proven to save lives. That’s appropriate polypharmacy. But too often, people end up with pills for problems caused by other pills. That’s where things go wrong.

A 2019 study from the American Academy of Family Physicians found that nearly 40% of adults over 65 in the U.S. are taking five or more medications. And for every extra pill added, the risk of harm goes up. One study showed that people on seven or more drugs had a 42% higher chance of mobility problems. Another found that those on ten or more medications were 28% more likely to die within a year than people on just one to four.

How Do Multiple Medications Cause Harm?

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. Drug interactions become more likely. And the brain gets more sensitive to sedatives, anticholinergics, and painkillers. The result? Side effects that look like aging-but aren’t.

- Falls and fractures: Medications like benzodiazepines (for anxiety), sleep aids, and even some blood pressure drugs can make you dizzy. Polypharmacy doubles your risk of falling. One in five falls leads to a broken hip-and that can end your independence.

- Confusion and memory loss: Anticholinergic drugs (found in some allergy pills, bladder meds, and antidepressants) block a brain chemical called acetylcholine. That’s fine for short-term use. Long-term? It’s linked to dementia-like symptoms. A 2020 study showed that people taking three or more anticholinergics had a 50% higher risk of cognitive decline.

- Drug interactions: When you’re on five or more drugs, the chance of a bad interaction jumps to 50%. For example, mixing blood thinners with NSAIDs (like ibuprofen) can cause internal bleeding. Or combining statins with certain antibiotics can damage your muscles.

- Medication cascades: This is one of the sneakiest problems. You take a drug. It causes dizziness. Your doctor prescribes a drug for dizziness. That makes you sleepy. Now you get a stimulant. Now you’re on seven pills to fix problems created by the first one. Studies show 30-40% of inappropriate prescriptions come from this cycle.

Who’s Most at Risk?

Older adults are the most visible group, but they’re not the only ones. People with multiple chronic conditions-like heart failure, diabetes, kidney disease, and depression-are often on 10 or more medications. Women over 65 are more likely than men to be on five or more drugs. And low-income seniors? They’re more likely to skip doses because they can’t afford them.

Martha, 72, told a UCI Health blog she was taking 17 pills a day. She couldn’t remember which ones she’d taken. Robert, 68, said his meds cost $400 a month-so he chose between his heart medicine and food. These aren’t rare stories. A 2022 Medicare survey found that 48% of people on five or more medications had side effects they blamed on their drugs. Nearly a third cut back on social activities because they felt too tired or confused.

The Cost Isn’t Just Health-It’s Financial

The average monthly cost for someone on five to nine medications? $317. For someone on one to four? $78. That’s not a typo. And that’s before insurance. For seniors on fixed incomes, that’s a huge burden. The National Council on Aging estimates polypharmacy adds $300 billion a year to U.S. healthcare costs-mostly from hospital visits, ER trips, and long-term care after falls.

And here’s the cruel twist: the more pills you take, the less likely you are to take them correctly. A 2021 study found people on ten or more medications were 3.2 times more likely to miss doses. Why? Complexity (58%), side effects (47%), and cost (65%). It’s not laziness. It’s impossible.

What Can Be Done? Deprescribing Is the Answer

The solution isn’t stopping all meds. It’s stopping the ones that don’t belong. That’s called deprescribing-the careful, step-by-step process of removing unnecessary or harmful drugs.

It’s not as simple as tossing pills. You need a plan. Here’s how it works:

1. Get a full medication list: Include prescriptions, over-the-counter drugs, vitamins, and supplements. Many people forget their OTC painkillers or sleep aids.
2. Review with a doctor or pharmacist: Ask: Is this still needed? Is it helping? Could it be causing harm? The American Geriatrics Society’s Beers Criteria lists drugs that are risky for older adults-like benzodiazepines, anticholinergics, and NSAIDs.
3. Start with the highest-risk drugs: Taper off sedatives, antipsychotics, or drugs with no clear benefit first. Don’t stop cold turkey. Some drugs need to be reduced slowly to avoid withdrawal.
4. Monitor closely: After removing a drug, watch for changes. Did your balance improve? Did your confusion clear up? Did your appetite come back?

A 2020 study found that a full medication review takes 25 to 40 minutes. That’s longer than most doctor visits. And only 35% of primary care doctors feel confident doing it. That’s why pharmacists are becoming key players in deprescribing. They’re trained to spot interactions and unnecessary prescriptions.

Real Success Stories

One Reddit user, a nurse named Jen, shared a case: a 78-year-old patient on 12 medications was constantly dizzy and confused. After removing three unnecessary drugs-including a sleep aid and an antihistamine-the patient’s balance improved, and they stopped falling. No new diagnosis. No surgery. Just less clutter.

Another study published in the Journal of General Internal Medicine found that patients who underwent structured deprescribing had a 40% drop in emergency visits over a year. Their quality of life went up. Their costs went down.

What’s Being Done to Fix This?

There’s progress. The FDA approved MedWise, a digital tool that flags dangerous drug combinations. In 2023, it reduced high-risk interactions by 37% in clinical trials. The American Geriatrics Society’s “Choosing Wisely” campaign has cut inappropriate prescribing by 22% in participating clinics. Medicare now requires medication reviews for people on eight or more drugs.

But systemic problems remain. Only 12% of medical schools teach polypharmacy. Fewer than 30% of primary care offices have systems to track complex regimens. And patients? Most don’t know to ask, “Should I still be taking this?”

What You Can Do Right Now

If you or a loved one is on five or more medications:

• Write down every pill, vitamin, and supplement you take. Include doses and times.
• Bring that list to your next doctor’s visit. Ask: “Which of these are still necessary?”
• Ask about the Beers Criteria-find out if any of your drugs are on the list of risky meds for older adults.
• Don’t be afraid to say, “I think this one might be causing problems.”
• Ask if a pharmacist can review your meds. Many pharmacies offer free med reviews.

It’s not about cutting corners. It’s about cutting clutter. Every pill you don’t need is one less risk. One less fall. One less hospital trip. One more day of living, not just managing.