If too many meds create too many side-effects, deprescribing might be the answer

Swallowing a handful of pills is a daily ritual for many people, from young adults coping with anxiety to older adults managing chronic conditions.

Overall, 13 per cent of people in the U.S. take five or more prescription drugs. For those 65 and older, that number is 42 per cent.

However, people taking multiple medications need to be aware of potential problems. One pill can lead to a side-effect, leading to another pill and another side-effect in what experts call a "prescribing cascade."

Some drugs can cause harm if taken for years. Others stop working or interact badly with a new drug. A drug tolerated well at first can cause side-effects later, leading to cognitive decline and injuries from falls.

"Our metabolism changes as we get older," said Dr. Elizabeth Bayliss, a researcher at Kaiser Permanente's Institute for Health Research in Aurora, Colo. "Everyone's ability to metabolize the medications they've been taking for a long time may change."

Bayliss studies deprescribing, which is a planned and supervised process to reduce or stop taking medications. 

Medication overload, as it's called by the non-profit Lown Institute, is a situation that it predicts will cause 4.6 million hospital visits this decade.

If your daily pill routine is getting out of hand, ask for a medication review. Here's how to get started.

Start with a professional you trust, like a doctor or pharmacist, said Lisa McCarthy, a pharmacist and deprescribing expert at the University of Toronto. 

If you're asking your doctor, don't wait until the end of a 15-minute visit. Instead, make a dedicated appointment and tell them when booking that you want to talk about your medicines, McCarthy said. 

Your doctor may not have the full picture of what you're taking if other prescribers are involved, and some doctors hesitate to manage drugs prescribed by others. That's when a pharmacist can help by reviewing everything and writing up suggestions you can share with your doctors, said pharmacist Bradley Phillips of the University of Florida College of Pharmacy.

"We're considered the medication experts," Phillips said.

Swelling, incontinence, restlessness, insomnia — all are side-effects caused by common medications that sometimes get treated with new drugs. McCarthy wants people to ask their doctors a simple question: Could this symptom be related to one of my medications?

"If we could teach the public to ask that question it would be very powerful," McCarthy said. And for a follow-up question, she suggested inquiring whether the problematic medicine is still needed.