TL;DR
A KFF Health News report describes growing concerns about medication interactions as more older adults take multiple prescriptions. Clinicians interviewed say patients can ask their doctors or pharmacists to review their full medication list and discuss whether any medicines can be safely tapered; they caution that deprescribing should be individualized, not a goal of simply reducing drug counts.
A KFF Health News report describes the risks that can arise when people take multiple medications and urges patients who are concerned about side effects to raise the issue with their doctors or pharmacists. The report’s central message is to review all prescriptions, vitamins and supplements with a clinician and discuss whether any medication can be safely reduced or stopped—not to change treatment without medical guidance.
The report recounts the experience of Jonathan Bledsoe, a Reading, Pennsylvania, resident who took medication for mood stabilization and cholesterol, among other drugs. After his urine became dark, he brought the symptom to his doctors and learned that an interaction between medications was beginning to damage his liver, according to the report. After he changed medications, his liver and kidney function returned to normal. His experience illustrates a potential risk; it does not establish how often similar interactions occur.
Polypharmacy, defined in the report as taking five or more medications, has become more common among older Americans. A study published in JAMA Internal Medicine found that the share of Americans over 65 taking at least five medications nearly doubled between 2000 and 2020. The report says more than a third of older adults now take five or more medications a day. Vanderbilt University hospitalist Amanda Mixon said she sees older patients taking an average of 16 medications, often prescribed by multiple clinicians and filled at different pharmacies.
Multiple prescriptions can contribute to side effects and drug interactions, and sometimes a side effect is treated with another medication, creating what clinicians call a prescribing cascade. The report gives the example of a water pill used for heart failure that increases urination; in some cases, the resulting incontinence may then be treated with another drug. Clinicians interviewed said patients should keep an up-to-date list of medications and supplements and bring it to appointments. Do not stop or taper a prescribed drug on your own; ask the prescriber about risks, alternatives and a safe plan.
Why Medication Reviews Matter
Medication review can help clinicians see the full combination a patient is taking, identify possible interactions and consider whether a drug’s benefits still outweigh its risks. That review may be especially relevant when several prescribers are involved or when a patient develops a new symptom after a medication change. The report notes that separate health systems may not share the same records, so no single clinician may have a complete list.
The concern is not limited to interactions between prescriptions. The report says age can change how the body processes medications, and lists potential adverse effects such as falls, constipation, diarrhea and memory loss. These are risks described by the interviewed expert, not proof that a particular medicine caused an individual’s symptoms. A clinician must assess a patient’s circumstances before recommending a change.
Deprescribing offers a way to address unnecessary or potentially harmful medicines, but the stated aim is patient safety, not reducing the medication count for its own sake. Some medicines need gradual tapering, and stopping them can carry risks. The report says the evidence and training on safe tapering are still developing, making professional oversight important.
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How Deprescribing Entered the Discussion
Deprescribing means intentionally reducing a medication or tapering it off when a clinician and patient determine that doing so is appropriate. The KFF Health News report says the practice has gained momentum over the past decade as concern about polypharmacy and medication-related harms has grown. It also reports that safe tapering is a newer area of practice and is not yet widely taught in medical schools, according to pharmacist DeLon Canterbury.
Canterbury, who leads the North Carolina-based consulting company GeriatRx, said the health system is skilled at diagnosing and treating conditions, but prescriptions can accumulate over time. He cautioned that patients should not assume someone is checking every medication in the background, particularly when different clinicians or pharmacies are involved. Pharmacist Jen Hammons, director of rural health advancement at the Appalachian College of Pharmacy, recommends carrying a current medication list; paper can work as well as a tracking app.
The report also notes a policy development: the Centers for Medicare & Medicaid Services released guidance this year clarifying how physicians and pharmacists can be paid for medication reviews and help with tapering when appropriate. Previously, clinicians reported uncertainty about payment for deprescribing work, which can take time. The report does not specify the guidance’s full scope or its effects on patient access.
““As you accumulate more and more medications, the chance of them interacting with each other and having bad interactions increases.””
— Amanda Mixon, hospitalist and associate professor of bioinformatics at Vanderbilt University
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Questions About Safe Tapering
The report does not identify which specific drug combinations account for the greatest risk or quantify how often medication interactions cause harm. Bledsoe’s experience is an individual case, and his outcome cannot predict what will happen to other patients. The figures on medication use describe population patterns, not whether every person taking five or more drugs is experiencing a problem.
It is also unclear from the report how many patients will be affected by the CMS guidance, how clinicians will apply it, or whether it will change access to medication reviews. The report says safe tapering is not yet widely taught, but does not give a single protocol that applies to every medicine. Decisions depend on the medication, the condition being treated, a patient’s health and the consequences of changing treatment. Patients should not stop or alter a medicine without consulting a qualified clinician.
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Bring a List to Your Clinician
For patients worried about a new symptom, a possible side effect or the number of medicines they take, the report recommends starting a conversation with a primary care provider or specialist. Bring a current list of prescriptions, over-the-counter drugs, vitamins and supplements, including doses if available, and explain when symptoms began or when a medication changed. A pharmacist can also help review the list, though the report cautions that no one should assume all prescribers already share complete records.
Patients can ask whether each medicine is still needed, whether two drugs may interact, what symptoms require prompt attention and whether a taper or alternative is appropriate. If a clinician recommends deprescribing, the patient and clinician can agree on a monitored plan and follow-up. The next developments to watch are how the CMS payment guidance is used and whether clinical education and practice around medication reviews and safe tapering expand.
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Key Questions
What does deprescribing mean?
Deprescribing is a planned process in which a clinician and patient consider reducing a medicine or tapering it off when its risks, benefits and ongoing need have been reviewed. It is not simply stopping treatment without guidance.
Should I stop taking a medication if I suspect a side effect?
No. Contact the clinician who prescribed it or another qualified health professional to discuss the symptom and next steps. Some medicines can cause harm if stopped suddenly, so any change should follow professional advice.
What should I include on a medication list?
List prescription medicines, over-the-counter drugs, vitamins and supplements. Include doses and how often you take them when possible, and update the list when something changes.
Why can taking medicines from several doctors be a concern?
Different prescribers or pharmacies may not have the same records. A current list shared with each clinician can help them review the full combination for possible interactions and side effects.
What did CMS change, according to the report?
The report says the Centers for Medicare & Medicaid Services released guidance this year clarifying how physicians and pharmacists can be paid for medication reviews and help taper medicines when appropriate. It does not detail the guidance’s full scope or its effects.
Source: rss
