Polypharmacy Case #1:
A long term client of mine showed up for her appointment. When she was lying face down on the table, I noticed that her right leg was twitching. I never saw her leg twitch in previous appointments.
I asked her if the twitching was something new, and she responded that it was. She recently experienced some physical trauma that led to some spinal issues. She was worried that the leg twitch was a result of this. She told me she tried to speak to her doctors about it, but no one wanted to deal with it and it is getting worse with time.
My first thought was to rule out if this was caused by medication that she might be taking. I asked her if she is on any medication, and if she didn’t mind telling me what meds she is taking.
Thankfully she trusted me and let me know she was on four different medications. I let her know I was going to look them up in an app that I use to check for possible side effects. Three of the medications had the side effect of muscle spasm/tremors.
I also cross-checked the meds to see if there were any interactions that might be contributing to the problem. Two of the drugs had an interaction with liver enzyme metabolism. This can affect how the drug is metabolized in the body and a possibility for stronger side effects, depending on the state of the patient’s liver health.
Once I let her know what I found out, she let me know that one of the prescriptions is new, and she has only been on it for about a month or so. She said that the tremors started not long after starting the new medication.
I then advised her to go back to her prescribing doctor and see what can be done. There was a strong enough correlation to conclude that the prescription drugs were possibly the cause of her leg twitching.
This is a perfect example of what is known as POLYPHARMACY.
Polypharmacy is when a patient is prescribed multiple medications to treat one or more conditions. The more prescriptions they will be taking, and it will be more likely that there will be possible drug interactions, or an increase in side effects.
Why does this happen?
In this day and age, with how the medical system is set up, doctors aren’t able to spend a sufficient amount of time with their patients to properly go through their history and medications. Most doctors only get about 15-20 minute face time with their patients. Many patients don’t even get a proper medical exam! Many times prescriptions are written up without even looking at what the patient is already taking.
Here is another example at how polypharamcy affected another client of mine:
Polypharmacy Case #2
She has an autoimmune condition, and was already taking one medication for this. Her doctor prescribed another medication to work as an adjunct to her initial prescription. Once she started the new drug, she noticed that her hands began to hurt and become weak. This became severe enough to the point she experienced difficulty lifting heavy objects and opening jars.
She took the two drugs together for several months when, after a recent trip to the pharmacy for a refill, the pharmacist let her know that her new prescription needed to be taken at a different time than her other medications due to drug interactions. She was in shock when she learned this because she already had multiple refills of this drug and this was the FIRST TIME anyone mentioned the possibility of interactions to her.
She was able to correlate her excessive hand pain/weakness with the interaction of the medications and that the symptoms started after taking the new drug.
Polypharmacy Case #3
I was in my internship in acupuncture school, and I had a new patient who was a male, late 20’s who was seeking help with weight loss and stress management. He reported that no matter what he did, he kept gaining weight. He suffered from depression/anxiety and wanted help with this.
On his intake, he mentioned that he was an avid marijuana smoker and alcohol consumer. This was a big part of his lifestyle and made it clear he wasn’t willing to do anything about this. Keep this in mind because marijuana can cause food cravings, and frequent alcohol consumption can cause weight gain.
When I reviewed his medication, I noticed he was on 5 different prescriptions from multiple doctors. He was taking psych medication and cardiovascular medications. Both of multiple meds had interactions with alcohol and marijuana. Some of his medications had more serious interactions and side effects than others.
Multiple drugs had weight gain as a side effect.
You can imagine how much good acupuncture and herbs will do when their lifestyle and medications are a big contributing factor for their chief complaint.
At his follow-up consultation, I presented him with a printout of my findings and advised him to return to his primary care doctor to discuss his medications and what options are available to help him reach his goal. I also let him know that I do not judge anyone for their use of any substances like weed or alcohol. Natural things do have their own side effects and can interact with drugs and it’s important for him to be aware of this moving forward. He was still more than welcome to continue to seek care with acupuncture, and I felt it could be very helpful with reducing his stress/anxiety levels. However, I was limited in how much I could help him with his weight loss goal until these other issues were taken care of first.
What can be done to prevent any dangerous effects of polypharmacy?
The best way a patient can prevent negative effects of polypharmacy from happening is to be very proactive with their own healthcare. Reading the insert that comes with medication is not enough because there is no way to check for drug interactions. I use the app, Medscape, to check any clients medications for possible side effects and drug interactions. It is very easy to use and provides lots of information about the medication. Here is some of whatI look for when I am reviewing medication for my clients:
Dosage and indications: this allows you to see what the drug is typically prescribed for in addition to some off-label use. It also allows you to see what dosages of the drug is available.
Note: Off-label means the drug is being prescribed for symptoms outside of it’s original purpose. An example is that when Ozempic first was on the market, it was originally for diabetes. Later doctors discovered it helps with weight loss, so they started to prescribe it off-label for weightloss. Another example is Wellbutrin is prescribed for depression. Due to it’s affects on dopamine and norepinephrine, doctors have prescribed it off-label for ADHD patients.
Adverse effects: Medscape lets you know what side effects are most prevalent for a prescription, and what side effects have been reported after the drug was put on the market.
Drug interaction: You can check all of your mediation against each other to look for possible interactions. It will let you know how severe the interaction is and if you need to talk with your doctor about using an alternate drug. It will also give you the reason why the interaction happens.
The list also includes some of the more popularly recommended supplements. Drugs and supplements can most definitely interact with each other and cause problems! Infact, one can experience polypharmacy by taking too many supplements! I have recommended to some herbal consult clients to take LESS supplements because they can mess up their care plan if they don’t know why they are taking so many supplements and how each one is affecting their body. It’s always best to work with an experienced practitioner to help you know what to take and when is the appropriate time to take it.
If you are interested in learning more about this, feel free to book a brief 10 minute consultation with me, or an herbal consult.
Pharmacology: This is one of my favorite parts of the app, as an herbalist. This lets you know how long the medication is supposed to last in the system and how it is metabolized and excreted from the body. This information is helpful because the state of the patient’s liver, kidneys, and colon play a big role in if a drug is metabolized properly, too fast (making it less effective), or if it ends up staying in the body for too long, thus increasing the likelihood of side effects.
It is very important that all patients take an active role in their healthcare and take the time to educate themselves on their care plan, what goals their provider has in mind for them, and what medications they are using to accomplish those goals. It’s also very important to ask your prescribing doctor how long they expect you to need to take the drugs they prescribe. Some drugs will be long term, some get taken for way longer than needed and end up causing other symptoms down the road.
Another way to prevent polypharmacy, especially if you feel that your doctor is not addressing your concerns about your medications, is to consult with your pharmacist! Patients do not utilize the immense knowledge that pharmacists have! If you have questions about your prescriptions, you can always ask your local pharmacist for information.