Managing Multiple Medications: How to Reduce Drug Interactions and Stay Safe

More than 4 in 10 adults over 65 take five or more prescription drugs every day. For many, that’s not a choice-it’s a necessity. Heart disease, diabetes, arthritis, high blood pressure, and depression often come together, each needing its own medication. But when you’re taking 10 pills a day, the risk of dangerous drug interactions goes up fast. It’s not just about mixing pills. It’s about how your body reacts, how your organs handle the load, and whether you even still need all of them.

What Is Polypharmacy-and Why Does It Matter?

Polypharmacy isn’t just having a lot of medications. It’s taking five or more at the same time regularly. That’s the threshold where the chance of harmful side effects, hospital visits, or even death rises sharply. The World Health Organization calls it one of the biggest patient safety issues today. But not all polypharmacy is bad. If every pill has a clear reason, works as intended, and you can take it safely, then it’s appropriate. The problem comes when medications are added without a plan, forgotten about, or used to treat side effects from other drugs.

Think of it like this: You’re on a bus with 10 people, and each person is holding a different tool. One has a hammer, another a screwdriver, another a wrench. If they all start using their tools at once, something’s going to break. That’s what happens in your body. One drug lowers your blood pressure. Another makes you dizzy. So your doctor prescribes a third drug to stop the dizziness. Now you’re on three drugs for what started as one problem. That’s a prescribing cascade-and it’s common.

How Do Dangerous Drug Interactions Happen?

Drug interactions don’t always show up right away. Sometimes, they build slowly. Here’s how they usually happen:

• Multiple doctors, no coordination. You see a cardiologist, a rheumatologist, a neurologist, and your GP. Each writes prescriptions without knowing what the others prescribed. A painkiller from one doctor might raise your blood pressure, but your heart doctor doesn’t know you’re taking it.
• Over-the-counter meds and supplements. People don’t think of aspirin, ibuprofen, or fish oil as “medications.” But they can interfere with blood thinners, kidney function, or blood sugar control. A 2023 study found nearly 60% of older adults on multiple prescriptions also took at least one supplement without telling their doctor.
• Old meds that don’t fit anymore. You took a medication for a past infection, a temporary condition, or even a symptom that’s now gone. But no one ever stopped it. It’s just sitting there, adding to the pile.
• Slowed metabolism. As we age, our liver and kidneys don’t process drugs as quickly. That means even normal doses can build up to toxic levels over time.

Some of the most dangerous combinations involve blood thinners like warfarin, diabetes drugs like insulin, and heart medications like beta-blockers. Mixing these with common pain relievers or herbal supplements can lead to internal bleeding, dangerously low blood sugar, or sudden drops in heart rate.

The Five-Step Safety Plan for Managing Multiple Medications

Managing polypharmacy isn’t about cutting pills. It’s about making smarter choices. The World Health Organization and major medical groups agree on a clear five-step approach:

1. Review every medication. Don’t just look at prescriptions. Bring everything-vitamins, herbal teas, sleep aids, cough syrups. Write down the name, dose, why you take it, and who prescribed it. If you can’t remember, take your pill organizer to your appointment.
2. Ask: Is this still needed? For every drug, ask your doctor: “What is this for? Is it still helping? Could it be causing side effects?” If a medication was started years ago for a condition that’s now under control, it might be safe to stop.
3. Look for prescribing cascades. If you’re taking a drug to fix a side effect of another drug, that’s a red flag. For example, if you’re on a diuretic that causes low potassium, and now you’re taking a potassium pill, that’s expected. But if you’re taking a stomach pill for nausea caused by a painkiller, maybe the painkiller should be changed instead.
4. Use the fewest pills possible. Ask if any drugs can be combined into one pill. Ask if you can switch to a once-daily version. Simpler regimens mean fewer mistakes and better adherence.
5. Deprescribe intentionally. Stopping a drug isn’t always easy. Some medications, like antidepressants or blood pressure pills, need to be tapered slowly. Stopping suddenly can cause rebound effects-your blood pressure spikes, your anxiety returns, or your heart races. Never stop a drug without your doctor’s guidance.

Deprescribing: When Less Is More

Deprescribing isn’t about taking fewer pills for the sake of it. It’s about removing drugs that no longer serve you. A 2024 review of clinical guidelines found that the most effective way to reduce harm from polypharmacy is through patient-centered medication reviews-where you and your doctor look at each pill together and decide what stays and what goes.

For example, an 80-year-old with mild dementia and high blood pressure might be on eight medications. One is for osteoporosis, but they haven’t had a bone density scan in five years. Another is a sleeping pill that makes them fall at night. A third is an old antibiotic that was prescribed for a urinary infection three years ago. After a review, three of those eight drugs were stopped safely. Their balance improved, their confusion lessened, and their risk of falls dropped by 40%.

Deprescribing works best when it’s slow and monitored. Your doctor might reduce a dose by 25% every two weeks. They’ll watch for symptoms. If you feel worse, they’ll pause. If you feel better, they’ll keep going. The goal isn’t to cut pills-it’s to cut risk.

Your Role: How to Take Control

You’re not just a patient. You’re the most important person in your medication team. Here’s what you can do right now:

• Keep a master list. Write down every medication you take-name, dose, time of day, reason, and prescriber. Use a notebook, phone app, or printable form from your pharmacy. Update it every time something changes.
• Use one pharmacy. All your prescriptions should come from the same place. Pharmacists can spot interactions your doctor might miss. They’ll flag if you’re getting two drugs that shouldn’t be mixed.
• Bring your pills to appointments. Don’t just say you take “the blue pill.” Show the bottle. Pictures help, but the actual bottle tells the pharmacist the exact strength and manufacturer.
• Link pills to habits. Take your morning pills right after brushing your teeth. Put your evening pills next to your bedtime glass of water. Routines reduce forgetfulness.
• Speak up about side effects. If you feel dizzy, tired, confused, or have new stomach pain, don’t assume it’s “just aging.” Tell your doctor. It might be a drug reaction.
• Ask before you try anything new. Don’t start a supplement, herbal remedy, or over-the-counter medicine without checking with your pharmacist or doctor first. Even “natural” can be dangerous.

Teamwork Makes It Work

Managing polypharmacy isn’t just your job-or your doctor’s. It takes a team. Pharmacists are your first line of defense. Nurses help track your progress. Caregivers can remind you to take pills and notice changes in behavior. When all of you are on the same page, mistakes drop.

Best practices include:

• Pharmacists doing full medication reviews during annual check-ups.
• Doctors using tools like the Beers Criteria-a list of medications that are risky for older adults.
• Hospitals and clinics doing medication reconciliation every time you’re admitted or discharged.
• Caregivers being included in discussions about treatment goals.

One Perth-based clinic started a program where every patient on five or more medications got a free pharmacist consultation every six months. Within a year, 32% of patients had one or more drugs stopped safely. Hospital visits for drug-related problems dropped by 27%.

What to Do If You’re Overwhelmed

If you’re taking a lot of medications and feel lost, you’re not alone. Start here:

1. Write down every pill, supplement, and OTC drug you take.
2. Call your pharmacy and ask them to print your full medication list.
3. Make an appointment with your GP-not a specialist. Ask for a “medication review.”
4. Bring your list and your pill organizer.
5. Ask: “Which of these are absolutely necessary? Which might be doing more harm than good?”

You don’t need to fix everything at once. One less pill this month is progress. One fewer interaction is a win.

Final Thought: Safety Isn’t About Quantity-It’s About Clarity

Having five medications isn’t dangerous. Having five medications with no clear purpose, no coordination, and no review is. The goal isn’t to take fewer drugs. It’s to take the right drugs, for the right reasons, in the safest way possible.

Medications save lives. But they can also harm you-if you don’t know why you’re taking them, or if no one’s checking if they’re still needed. Ask questions. Keep records. Speak up. Your health isn’t just about what’s in the bottle. It’s about what’s in your head-and who’s helping you think clearly.

Managing multiple medications isn’t about memorizing a long list. It’s about staying curious, asking questions, and working with your team to keep things simple, safe, and effective. The goal isn’t to take fewer pills-it’s to take only the ones that truly matter.