Empowering Patients With Complex Regimens: The Pharmacist’s Role in Managing Polypharmacy

Polypharmacy, defined as the use of 5 or more medications at the same time, is epidemic.^1,2 More than 20% of adults in the United States aged 40 to 79 years use at least 5 prescription drugs and are exposed to the heightened risks associated with polypharmacy.¹ Their medications may be appropriate and necessary, especially when they have been diagnosed with multiple disease states, or the medications may be inappropriate. Awareness and, when possible, avoidance of polypharmacy are essential. Polypharmacy is associated with increased cost burden, drug interactions, a greater likelihood of adverse drug events, and nonadherence. In older adults, fall risk and cognitive impairment also become factors.^2-4

Moreover, patients with multiple conditions often see multiple providers, all of whom may focus only on the conditions they are individually responsible for managing.³ Prescriptions and recommendations can accumulate with each appointment. Patients may also visit multiple pharmacies to fill those prescriptions. To that end, no single health care provider may be aware of a patient’s full medication list.

We Can’t Fix What We Don’t Know

An up-to-date and complete medication list is necessary to identify polypharmacy and evaluate each medication. Pharmacists or other health care professionals can provide formal services such as comprehensive medication reviews and medication therapy management to ensure complete data collection before taking any action to reduce burden.⁵ Review and management can occur in any setting, whether it be inpatient, outpatient, or at a retail pharmacy.⁶ As noted, patients who receive prescriptions from multiple providers often fill those prescriptions at multiple pharmacies, leaving each provider with a partial picture. Encouraging patients to maintain an updated medication list and bring it to all appointments is a good place to start.

Importantly, polypharmacy does not solely refer to prescription products. The same risks apply to OTC products.⁷ Discussing nonprescription drug products with patients is just as important as discussing prescriptions. For example, some OTC antacids and dietary supplements interact with tetracycline antibiotics, so patients must take them at different times of day.⁸ Because unnecessary daily OTC medications can add to the polypharmacy burden, clinicians should evaluate their continuation as seriously as prescription medications.

What’s Your Patient’s Point of View?

The burden of polypharmacy varies. Some patients may feel equipped to manage more medications than others. This is why talking through each patient’s medication regimen is important. Expectations can differ from person to person, and involving patients in decision-making can increase patient satisfaction.⁹ Additionally, patients may have different priorities than providers when it comes to making changes. Patients tend to prioritize reducing medication adverse events over expected benefit, whereas providers are more concerned about preserving benefit.¹⁰ Both points of view are valid to consider when it is time to take medications off the list.

We expect patients to manage their own medications, but knowing how becomes harder with each medication or supplement added to their regimen. Pharmacists can be a source of information and support when organizing medications and understanding how each should be stored and used.¹¹ Patients should feel comfortable voicing concerns about the downsides of medications, even when the medications are appropriate. The patient is the one who directly experiences the adverse events and pays the co-pay each month. Pharmacists should encourage honesty about any barriers or concerns the patient may have with new medications.

Consolidation

Changing or stopping a medication must be based on the risks and benefits pertinent to each situation. When a provider identifies high-risk medications that may be appropriate to alter, it is important to make one change at a time. This makes it clearer to the patient and easier to determine any positive or negative effects.¹² Pharmacists may have unique knowledge of medication formulations that can ease the burden of polypharmacy. For example, extended-release once-daily and combination formulations are ways to simplify a regimen without changing active ingredients.

Conclusion

Polypharmacy elevates a patient’s risk profile. Discussing a patient’s entire medication list is important because it may extend beyond what a single provider or pharmacy is aware of and because patients have varying levels of health literacy and comfort with managing medications. If taking medications off the list is necessary, patient and provider priorities may differ, so patients should be actively involved in decisions when possible. The Table¹¹ lists tools that can streamline the process of adjusting medications and deprescribing.

Although reducing medication load, when possible, is important, encouraging patients to be active in their medication regimen is equally vital.

About the Author

Jordyn Belcourt, BS Pharm, is a 2027 PharmD candidate at the University of Connecticut School of Pharmacy in Storrs.

REFERENCES

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2. Medication Safety in Polypharmacy. World Health Organization; 2019. Accessed December 10, 2025. https://www.who.int/docs/default-source/patient-safety/who-uhc-sds-2019-11-eng.pdf

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7. Your guide to managing multiple medications with pharmacist Mandy Leonard. Cleveland Clinic. July 29, 2020. Accessed December 10, 2025. https://my.clevelandclinic.org/podcasts/health-essentials/your-guide-to-managing-multiple-medications-with-pharmacist-mandy-leonard

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9. Havelikar U, Sonawane HK, Khandare RS, et al. Optimizing patient care: an inclusive review of polypharmacy and the vital role of pharmacists in mitigation. Intell Hosp. 2025;1(1):100006. doi:10.1016/j.inhs.2025.100006

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