Polypharmacy

Polypharmacy is the use of multiple medicines by one individual. It is becoming increasingly common due to factors such as an ageing population and the rising prevalence of multimorbidity.

Inequalities in polypharmacy are more evident in:

• areas of deprivation
• people from ethnic minority backgrounds
• older people especially those living with frailty
• some people with mental health conditions or disabilities.

Historically, polypharmacy was commonly defined as the use of five or more medicines. More recently it’s been acknowledged that some patients may need to take multiple medicines to manage their conditions. Therefore, polypharmacy is now described as either appropriate or problematic.

Appropriate polypharmacy

Appropriate polypharmacy refers to the use of multiple medications that are clinically indicated, optimised and prescribed according to best evidence. They extend life expectancy and improve quality of life for the patient.

Problematic polypharmacy

Problematic polypharmacy, sometimes referred to as inappropriate polypharmacy, occurs when:

• medicines are no longer appropriate
• benefits don’t outweigh harms
• combinations cause or risk harm
• usage becomes unmanageable or distressing.

Hyperpolypharmacy refers to the use of ten or more medicines. It is common in older people, especially those living with frailty.

Oligopharmacy refers to the intentional practice of minimising the number of regular medications, typically keeping it to fewer than five. It is a common approach in end-of-life care to reduce the burden of polypharmacy and focus on symptom management.

Consequences of polypharmacy

The number of medicines prescribed in the NHS has risen significantly. However, it is estimated that around 10% of medicines prescribed in primary care are inappropriate.

Polypharmacy increases the risk of:

• adverse drug effects
• medication errors
• drug interactions
• non-adherence
• risk of falls and frailty
• cognitive impairment
• hospital admissions
• health care costs.

Overprescribing

Consequences of overprescribing

The negative consequences of overprescribing include poor patient outcomes such as:

• adverse drug effects
• increased medicine-related hospital admissions
• higher NHS costs and resource use
• medication waste, which also contributes to a larger carbon footprint.

The Department of Health and Social Care’s National Overprescribing Review highlights the clinical and financial consequences to overprescribing in England:

• 8.4 million patients regularly take 5 or more medicines.
• 1 in 5 hospital admissions in patients aged over-65 result from adverse drug effects.
• The risk of harm increases with the number of medicines taken.
• Patients on 10 or more medicines are 300 times more likely to face drug-related hospital admissions.
• 10% of prescriptions in primary care are inappropriate, with alternative treatments often better for a patient’s needs and preferences.

Addressing problematic polypharmacy and overprescribing

Tackling overprescribing requires a system-wide approach requiring collaboration, support and behaviour change from clinicians, patients and their carers.

Personalised care and shared decision-making also help improve the culture of prescribing. More resources are being directed into primary care, including expanding medicine optimisation, structured medication reviews, medicines reconciliation, deprescribing and social prescribing. For more information, see NHS England’s resources on personalised care, shared decision making and structured medication reviews.

The National Overprescribing Review notes that medicines optimisation is key to addressing overprescribing. It provides a framework that ensures patients receive the right medicines, at the right time, and in the right doses.

NHS England’s national medicines optimisation opportunities 2024/25 has identified problematic polypharmacy as a key medicine optimisation priority.

The four principles of medicines optimisation are:

• understanding the patient’s experience
• making evidence-based medicine choices
• ensuring safe medication use
• embedding medicines optimisation into routine practice.

The Health Innovation Network Polypharmacy Programme offers a range of resources including Polypharmacy Action Learning Sets. These evidence-based sessions have been shown to enhance healthcare professionals’ confidence in de-prescribing and managing complex medication issues effectively.

Deprescribing

Deprescribing is a complex process that refers to tapering, stopping, discontinuing, or withdrawing of medications that are no longer appropriate, beneficial or wanted. It is guided by a patient centred approach involving shared decision making with the patient (and their carer if appropriate), with follow up review and support.  

The National Overprescribing Review and the BNF’s medicines optimisation advice highlight deprescribing as essential for reducing inappropriate polypharmacy, particularly for older patients at risk of medication-related harm.

The benefits of deprescribing are wide-ranging and impactful:

• Reduces harms: minimises drug reactions, drug interactions, and errors.
• Improves outcomes: focuses on effective treatments and avoids unnecessary interventions
• Enhances quality of life: simplifies regimens, improves adherence, and reduces side effects.
• Patient-centred: aligns care with patient goals, particularly in frailty or end-of-life care.
• Cost-effective: lowers healthcare costs by reducing unnecessary medications.

The SPS article on a person-centred approach to polypharmacy and medication review can be used as a framework when undertaking structured medication review and deprescribing.

Further information

A person-centred approach to polypharmacy and medication review

This  SPS article on a person-centred approach to polypharmacy and medication review outlines how to identify and invite patients for a structured medication review. It also includes a practical framework to manage inappropriate polypharmacy using a person-centred approach. 

Resources to support medication review

This SPS article on resources to support medication review highlights resources to support healthcare professionals manage problematic polypharmacy and facilitate shared decision making.

Tools to support medication review

This SPS article on tools to support medication review highlights tools to support medication review by identifying inappropriate medicines, guiding deprescribing, and empowering patients via shared decision making.

Update history