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A KFF Health News report describes how medication combinations can cause harmful side effects and discusses deprescribing, the supervised reduction of medications when appropriate. More than one-third of adults over 65 take at least five medications, according to a study cited in the report. Patients concerned about their prescriptions should discuss them with a clinician and should not stop medication on their own.
A KFF Health News report is urging people who take several medications to keep an up-to-date list and discuss possible side effects or medication reductions with their health care providers. The report follows the case of Jonathan Bledsoe, whose doctors found that an interaction among his medications was beginning to damage his liver; after a medication change, his liver and kidney function returned to normal, the report said.
Bledsoe, a Marine veteran from Reading, Pennsylvania, had taken medication for mood stabilization and cholesterol, along with other prescriptions, for nearly three years. He sought medical advice after noticing that his urine had turned dark. He told the report that he had not expected to have to advocate for himself in managing his medicines. His case illustrates a risk of multiple prescriptions, but does not establish how common that specific outcome is.
The report cites a study published in JAMA Internal Medicine showing that the share of Americans over 65 taking five or more medications nearly doubled between 2000 and 2020. More than one-third of older adults now take at least five medications a day, according to the report. Amanda Mixon, a hospitalist and bioinformatics associate professor at Vanderbilt University, said she sees older patients taking an average of 16 medications, often prescribed by different clinicians and filled at different pharmacies.
One concern is a “prescribing cascade”: a medication causes a side effect, another drug is added to address that effect, and further problems can lead to still more prescriptions. Mixon gave the example of a water pill prescribed for heart failure that increases urination; in some cases, incontinence may then be treated with another medication. The report says patients should include vitamins and supplements on their medication lists, since clinicians need a full picture of what a person takes.
How Medication Combinations Add Risk
Medication reviews can matter because side effects and interactions may be hard to identify when care is spread across several prescribers or health systems. Mixon said that as medications accumulate, the chance of interactions and adverse effects increases. The report also notes that aging can change how the body processes medicines, potentially raising the likelihood of effects such as falls, constipation, diarrhea, or memory problems.
Deprescribing means intentionally reducing or stopping a medicine when a clinician determines it is no longer needed or its risks outweigh its benefits. It is not a recommendation to stop as many drugs as possible. DeLon Canterbury, a pharmacist and chief executive of GeriatRx, told the report that the aim is patient safety. Some medicines need to be tapered, and stopping a prescription without medical guidance can be unsafe.
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The Push for Medication Reviews
The report describes greater attention to deprescribing over the past decade, alongside increased use of multiple medications and concerns about related risks. Canterbury said the evidence and practice of tapering medicines safely are comparatively new and are not yet widely taught in medical schools. That can make a planned reduction a matter for discussion and follow-up, rather than a simple decision to stop a drug.
Multiple prescribers may not have access to the same records, especially when they work in separate health systems. Canterbury cautioned patients not to assume that a pharmacist or another clinician is checking every medication combination in the background. The report also says the Centers for Medicare & Medicaid Services issued guidance this year clarifying how physicians and pharmacists can be paid for medication reviews and help with tapering when appropriate. The report does not provide further details about the guidance’s implementation.
““As you accumulate more and more medications, the chance of them interacting with each other and having bad interactions increases.””
— Amanda Mixon, hospitalist and bioinformatics associate professor at Vanderbilt University
What the Report Does Not Establish
The cited study tracks how many older adults take five or more medications; the report does not give a precise current survey date for the “more than one-third” figure or detail how medication use was measured. Bledsoe’s experience is an individual case and cannot show how often medication interactions cause liver damage. The report also does not identify the specific medicines involved in his interaction.
It remains unclear how broadly clinicians will use the newer Medicare payment guidance, or how much it will change access to medication reviews. Deprescribing decisions depend on a person’s prescriptions, health conditions, and risks. The report does not offer a single tapering schedule or a list of medicines that should generally be stopped.
Starting a Clinician-Led Review
People concerned about side effects or the number of medicines they take can bring a complete, current list to a primary care clinician or relevant specialist and ask whether each medication is still needed. The list should include prescriptions, over-the-counter medicines, vitamins, and supplements. Patients can describe new symptoms and ask whether a drug interaction or side effect could be involved.
Any reduction or change should be planned with a health professional who knows the patient’s care. The next step is an individualized review and, if appropriate, a supervised taper with follow-up. The report provides no timetable for future policy changes or for broader adoption of deprescribing practices.
Key Questions
What does deprescribing mean?
Deprescribing is the planned reduction or stopping of a medication when a clinician judges that it may no longer be needed or its risks warrant a change. Some medicines require gradual tapering, so patients should not stop them on their own.
Why keep a medication list?
A current list helps clinicians see the full combination of medicines a person uses, including over-the-counter drugs, vitamins, and supplements. That can support a review for possible interactions, duplicate treatments, or side effects.
Should I stop a medication if I suspect a side effect?
Contact the prescribing clinician or another appropriate health professional to discuss the symptom and next steps. Do not stop or change a prescription without medical guidance, since some medicines need to be reduced safely.
What did the report say about older adults and multiple medications?
The report cited a study in JAMA Internal Medicine that found the share of Americans over 65 taking five or more medications nearly doubled from 2000 to 2020. It reported that more than one-third of older adults take at least five medications a day.
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