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

Taking five or more medications every day isn’t uncommon-especially if you’re over 65 or managing several long-term health conditions. But the more pills you take, the higher your risk of dangerous drug interactions. These aren’t just theoretical risks. They cause hospitalizations, falls, confusion, kidney damage, and even death. The good news? You don’t have to accept this as normal. With the right approach, you can cut down on unnecessary meds, avoid harmful overlaps, and take only what truly helps you.

What Exactly Is Polypharmacy?

Here’s the reality: 44% of older adults in the U.S. take five or more prescription drugs. One in five take ten or more. Many are on medications that no longer help, or that were prescribed to fix problems caused by other drugs. That’s called a prescribing cascade. For example, a blood pressure pill causes dizziness, so a doctor prescribes a balance medication. That new drug causes dry mouth, so now you get a saliva spray. It’s a chain reaction-and it’s avoidable.

Why Drug Interactions Happen

• Two or more prescription drugs
• A prescription and an over-the-counter (OTC) medicine like ibuprofen or antacids
• A medication and a supplement like fish oil, vitamin E, or St. John’s Wort
• A drug and a food-like grapefruit and statins

These interactions can make a drug too strong, too weak, or cause side effects you didn’t expect. For instance, mixing blood thinners like warfarin with certain antibiotics can spike your bleeding risk. Taking too many painkillers with kidney issues can damage your kidneys over time. And some meds-like benzodiazepines for anxiety-can make you dizzy or confused, increasing fall risk in older adults.

The biggest problem? Most people don’t tell their doctors about everything they take. They think OTC meds and supplements are “safe.” They’re not. A 2023 review found that nearly 60% of patients on multiple medications weren’t even asked about their supplements during a doctor’s visit.

The Five-Step Safety Plan

1. Review every medication-Ask your doctor: “Why am I taking this? Is it still needed?” Don’t assume it’s still useful just because you’ve taken it for years.
2. Use the Beers Criteria-This is a list of medications that are risky for older adults. Your pharmacist can check your list against it. Common offenders include certain sleep aids, antihistamines, and muscle relaxants.
3. Deprescribe wisely-Stopping a drug isn’t always simple. Some meds need to be tapered slowly. Stopping an antidepressant or blood pressure pill suddenly can cause rebound effects. Never quit cold turkey.
4. Keep a master list-Write down every pill, patch, inhaler, and supplement. Include the dose, why you take it, and who prescribed it. Bring this to every appointment-even if you think you’ve told them before.
5. Use one pharmacy-If you get prescriptions from multiple doctors, use the same pharmacy every time. Pharmacists can spot dangerous overlaps you might miss.

Deprescribing: When Less Is More

Here’s how to start:

• Ask: “If I stopped this, what would happen?” If the answer is “I’d be fine,” it might be a candidate.
• Look for meds prescribed to treat side effects of another drug. These are prime targets.
• Check if your health goals have changed. If you’re no longer aiming for aggressive blood sugar control because of age or other conditions, some diabetes meds may no longer be needed.
• Start with one. Don’t try to stop five at once. Pick the one with the lowest benefit and highest risk.

Some people worry that stopping meds means giving up on their health. But the opposite is true. You’re choosing to focus on what actually improves your day-to-day life-like staying active, sleeping well, or avoiding hospital trips.

Your Role: Be the Boss of Your Meds

• Bring all your meds to every appointment-bottles, pills, patches, even the ones you haven’t taken in months.
• Use a pill organizer with alarms. But don’t just fill it blindly. Double-check the labels each week.
• Link taking meds to daily habits: “I take my heart pill after brushing my teeth.”
• Report any new symptom-dizziness, nausea, confusion, rash, sleep changes-immediately. Don’t wait for your next appointment.
• Ask: “Can we try going off this for a few weeks to see how I feel?” Many doctors will agree if you’re monitored.

And never, ever stop or change a dose based on advice from a friend, online forum, or social media. Even “natural” supplements can interact dangerously. St. John’s Wort, for example, can make antidepressants, birth control, and blood thinners useless-or dangerous.

Teamwork Makes It Work

• Your doctor-reviews your goals and diagnoses
• Your pharmacist-spots interactions and simplifies regimens
• Your nurse-helps with education and follow-up
• Your caregiver or family member-helps track pills and report changes

Studies show that when pharmacists are part of the care team, hospitalizations from drug problems drop by up to 30%. That’s not magic-it’s because pharmacists know what’s in each pill and how they react together.

Ask your doctor if you can schedule a medication review with a clinical pharmacist. Many clinics now offer this as a free service. If you’re on Medicare or private insurance, ask if it’s covered.

What to Do After Your Appointment

• Get a written update-list of what to keep, what to stop, and what to change.
• Ask for a timeline: “When should I start reducing this? How will I know it’s working?”
• Set a follow-up date-three weeks after a change, or sooner if you feel off.
• Update your pill organizer and your master list right away.

Don’t wait for the next annual checkup. If you’re on five or more meds, schedule a review every six months. That’s not overkill-it’s essential.

Real-Life Example

Her story isn’t rare. It’s the result of asking the right questions-and being heard.