The Janus face of polypharmacy – overuse versus underuse of medication

Abstract

As modern guidelines may recommend several drugs for a single medical condition, it follows that many patients, especially if co-morbidity is present, use a number of medications. Also, an aging population implies more morbidity and consequently will have the result that many patients use many drugs – a situation often referred to as polypharmacy. Polypharmacy has been linked to negative health outcomes such as adverse drug reactions, interaction problems, poor patient adherence, and hospitalisations. Such experiences have led to the attitude that efforts should be made to reduce polypharmacy. However, this approach might prevent patients from obtaining optimal treatment. There is no universal definition of polypharmacy and measuring of a reduction in polypharmacy becomes problematic. Because polypharmacy is an imprecise term it should be used with caution in research as well as in patient management. Moreover, studies have shown that undertreatment occurs frequently also among patients using many drugs. This is the Janus face of polypharmacy: too many drugs should be avoided, but the individual patient should receive the appropriate drugs that have the potential to reduce morbidity and improve quality of life. It is the individual drugs themselves, along with patient specific factors, and not a fixed number of drugs, that we should pay attention to.