Am I taking too many tablets?

Medications can improve the lives of people who suffer from chronic health problems. These include diabetes, high blood pressure, high cholesterol, cancer, mental illness and chronic pain. When you are first prescribed a medication it is usually the best one for you at that time. However, things can change over time and medication can cause harm.

• You may develop a side effect to a medication, even if you have been taking it for a long time with no problems.
• Your health may have changed, such as developing a long term condition or a change in a long term condition you already have. This means you may react differently to medication.
• Your medication may interact with another medication you are taking.

The chance of suffering from harmful effects, drug interactions and emergency hospital admissions increases when you take more medications. Taking lots of medicines is called polypharmacy.

Harmful effects of medications can include:

• Falls and broken bones
• Memory problems including dementia
• Emergency hospital admissions
• Premature loss of independence

More than 1 in 10 emergency hospital admissions are due to medication problems. For patients over the age of 65, half of these emergency admissions could be prevented.

Any of these reasons, as well as others can mean that some medications might not be right for you anymore.

Deprescribing means reducing or stopping medications that may not be helpful for you or may be causing you harm. The goal of deprescribing is to maintain or improve your quality of life. Deprescribing is happening across Scotland and further afield.

Deprescribing involves patients, caregivers, and healthcare providers. It is very important that you do not stop or reduce your medications without speaking to your doctor first. Some medication needs to be reduced slowly. Stopping it suddenly could cause harm.

Many of the patients in the practice are willing to reduce or stop some medications following a discussion with one of the GPs.

Some medications are considered to be particularly risky—or potentially inappropriate—for people over 65.  Inappropriate prescriptions are those where the risks to your health are greater than the benefits, and there are safer alternative treatments which are more or equally effective for treating the same condition.

Risky medications are associated with higher incidence of medication-related harms such as memory problems, falls and fractures.

Below is a list of a few of the medications considered to be risky, especially for people over age 65. When appropriate, these drugs should be considered for reducing or stopping. Speak to your doctor to learn more about safer alternative treatments.

• Anti-cholinergic medications – this is a big group of medication used for lots of different problems (e.g. amitriptyline, oxybutynin, paroxetine, promethazine). Find out more about anti-cholingerics. 
• Anti-inflammatory medications such as ibuprofen or naproxen (non-steroidal anti-inflammatory drugs or NSAIDs). 
• Antipsychotic medication when used as a sleeping pill or for dementia behavioural and psychological symptoms (e.g. quetiapine, risperidone). 
• Medications for allergies and itchiness: first-generation antihistamines (e.g. diphenhydramine/chlorphenamine). 
• Opioid medication for chronic pain (e.g. co-codamol, codeine, dihydrocodeine, tramadol, morphine, oxycodone). 
• Other medication for pain (e.g. amitriptyline, pregabalin, gabapentin). 
• Sleeping pills/anti-anxiety medication (e.g. diazepam, zopiclone). 
• Stomach pills for acid reflux: proton-pump inhibitors (e.g. omeprazole, lansoprazole). 

Find out more about each of these medications at Manage my meds.

Every year the GPs look at the repeat (regular) prescriptions that our patients are taking. If we see that someone is on lots of medication or medication which may be causing harm, we may arrange a telephone or face to face appointment to discuss the medication.

The decision to reduce or stop a medication is a shared decision between patients and healthcare professionals.

If a medication is reduced or stopped, we may discuss another way to manage the condition. For example, changes in diet can be a safe and effective way to prevent heartburn and reflux without the need for any medication.

Start a conversation

Good communication with your doctor, pharmacist and/or nurse is essential to ensure safe and effective health care.

To start a conversation, here are some questions you can ask about your medications:

• Why am I taking this medication? 
• What are the potential benefits and harms of this medication?  
• Can it affect my memory or cause me to fall? 
• Can I stop or reduce the dose of this medication (i.e. deprescribing)? 
• Who do I follow-up with and when? 

If you don’t know the answers to the above questions, ask your doctor, nurse or pharmacist at your next visit.

Understand your medications

Keeping track of many medications is difficult even for trained professionals. Do you keep a record of which medications you’re taking, the dosage, and when and why they were prescribed? You can ask your doctor about this. Don’t forget to include natural products as well as over-the-counter medications (bought without a prescription).

Talk to your doctor or nurse

Up to half of all patients do not take their medication in the way that it is intended by the healthcare team. This may be due to a misunderstanding or they may be having a problem with the medication. It is really important that you tell your doctor or nurse how you are taking your medication, especially if you think it might be different from the instructions. This means that any changes in medication can be made safely.

Please tell your doctor or nurse if you have stopped taking any medication (even if you think they want you to continue it). You won’t get into trouble! It’s very important that we know what medication you are taking so that we can help you to look after your health in the best way for you. 

Alternatives to risky medication

Alternative therapies are often available, which may be equally or more effective than the medication you are currently taking. Alternatives can include other prescription medications or over the counter medications. Certain lifestyle changes (diet, sleep, exercise) can help treat some health problems. Here are some examples:

Alternative to sleeping pills: proper sleep hygiene and cognitive behavioural therapy.

Better management of type-2 diabetes: regular physical activity, healthy diet and a healthy body weight.

Alternative to stomach pills for acid reflux (proton-pump inhibitors): a change in diet, a healthy body weight and antacids like Gaviscon or Peptac.

Medication can have negative effects on the environment. Lots of medication is flushed down sinks and toilets or thrown into landfill. Even when medication is taken, a lot of it leaves the body in the urine. Sewage treatment plants can only remove 80% of this. This means that a lot of medication is entering the environment and affecting plants, fish, and animals (Pharma in the Environment).

Please get rid of any unused medication by returning it to your pharmacy. They are able to dispose of it safely.

You can dispose of empty medication packets at various drop off points including Superdrug pharmacies.

For more information about reviewing your medications, please see the NHS Scotland website Manage My Meds.