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Could You Be Taking Too Many Medicines?

As we get older, medicines add up — but more is not always better. Sometimes the very medicines meant to help can cause harm. This guide is about knowing when to ask, “do I still need all of these?”

What is “polypharmacy”?

It simply means taking several medicines at once — often five or more. It is very common as we age, and usually each medicine was started for a good reason, sometimes by different doctors at different times. The problem is that no one always steps back to look at the whole list together.

Why can taking many medicines be a problem?

The more medicines you take, the greater the chance they clash or cause side-effects. Two of the most common reasons older people end up in A&E because of their medicines are falls — some medicines cause drowsiness, dizziness or low blood pressure — and bleeding, from blood-thinning medicines. The two can combine: a blood thinner makes a simple fall far more dangerous.

What is a medicines review?

It is a planned check of everything you take, with your doctor or pharmacist. Together you ask of each medicine: is it still needed, still working, still safe, and still right for you? Sometimes the safest, healthiest change is to reduce or stop one — always done gradually and with proper monitoring. Doctors call this “deprescribing”.

What can I do?

Keep an up-to-date list of your medicines and take it to every appointment. If you take several, ask your GP or pharmacist for a medicines review — you are entitled to one. Mention any new symptoms, because they can sometimes be a side-effect rather than a new illness.

Ten Steps to Tackle Polypharmacy

A plan to reduce the iatrogenic harm of too many medicines in an ageing population — and to make deprescribing routine, accountable and safe.

The problem in one line

Medication-related falls and anticoagulant bleeding are now among the commonest reasons older people reach the emergency department — two faces of the same epidemic: polypharmacy in an ageing population, driven by single-disease guidelines and incentives that reward starting drugs over stopping them. The medicines that should help are, too often, the cause of harm.

Give the medicine list an owner. One named, accountable clinician for the whole list of every patient on five or more medicines — so that someone, at last, is responsible for subtracting as well as adding.
Make structured review mandatory and funded. An annual STOPP/START- or Beers-informed review (or the NHS Scotland seven-step model) for everyone on five or more medicines, or any anticoagulant, sedative, opioid, antihypertensive or hypoglycaemic.
Flip the incentives. Reward safe de-intensification, not just initiation and single-disease target-hitting. Add deprescribing metrics; scrap targets that punish loosening control in the frail.
Rewrite guidelines for the multimorbid. Guidelines built on trials that excluded older, frailer patients must carry explicit stopping rules and frailty-stratified targets — not just escalation ladders.
Hunt the prescribing cascade. Train every prescriber to ask “could this new symptom be a drug side-effect?” before adding a medicine — and build the prompt into electronic prescribing.
Put pharmacists where the harm happens. Embed clinical pharmacists in primary care and at every care transition; hospital discharge and care-home admission are the highest-yield — and most fumbled — moments.
Deprescribe the worst offenders by default in frailty. Long-term benzodiazepines and Z-drugs (zopiclone / eszopiclone, zolpidem, zaleplon), anticholinergics (amitriptyline, nortriptyline, oxybutynin etc.), NSAIDs in the anticoagulated or renally impaired, and antithrombotic doublets should need justifying to continue, not effort to stop.
Treat anticoagulation as a decision under constant review. Reassess bleeding-versus-stroke balance, falls risk, renal function and dose at least yearly — because the anticoagulated faller is where falls and bleeds combine to kill.
Fund the evidence industry never will. Commission large, long, hard-outcome deprescribing trials. The current evidence gap is a commissioning failure, not a reason to keep prescribing.
Make “what matters to you” routine. Align medicines with the patient’s own goals — function, independence, freedom from side-effects — and give patients the words to ask: “do I still need all of these?”

Never stop a medicine on your own. Stopping suddenly can be dangerous. Any change should be planned with your doctor or pharmacist, who can do it safely and keep an eye on how you get on.

Questions to ask at your medicines review

Do I still need every one of these medicines?
Is any of them more likely to do harm than good for me now?
Could any be making me dizzy, drowsy, or more likely to fall?
If I take a blood thinner, is the dose still right for me?
Could any be reduced or stopped — and how would we do that safely?

This Practical Guide, produced by the Education Directorate of IIMHE, is only for educational and communication purposes. It gives general information only and is not a substitute for personal medical advice. Medicines have both benefits and risks, and decisions about them should always be made with your primary care physician or pharmacist. · IIMHE, June 2026