polyfarmaci

Polyfarmaci, or polypharmacy, is the concurrent use of multiple medications by a patient. It is commonly defined as taking five or more medicines at the same time, including prescription drugs, over-the-counter products, and supplements. The phenomenon is most common among older adults and people with multiple chronic conditions, but it can occur at any age. Contributing factors include multimorbidity, fragmented care, multiple prescribers, transitions in care, and self-medication.

Risks associated with polyfarmaci include adverse drug events, drug interactions, diminished adherence, and higher rates of hospitalizations. Some medications, such as sedatives, anticholinergics, and anticoagulants, carry particular risks in vulnerable populations and can worsen cognitive or functional status.

Assessment and measurement: Clinicians quantify polyfarmaci by counting medications and may use tools such as defined daily dose (DDD) or the Medication Regimen Complexity Index (MRCI). Screening instruments like STOPP/START and Beers criteria help identify potentially inappropriate medications, especially in older adults. Medication reconciliation at care transitions is essential.

Management strategies emphasize optimization and safe simplification. Practices include regular medication reviews, structured deprescribing when appropriate, minimizing duplications, choosing simpler regimens, and aligning therapy with patient goals. Education for patients and caregivers and coordination among prescribers and pharmacists support safer prescribing.

Outcomes: Properly managed polyfarmaci can be necessary for complex conditions. When unnecessary medications are stopped or avoided, the risk of adverse events and hospitalizations typically decreases, while adherence and quality of life may improve. Evidence supports routine, patient-centered medication reviews in chronic disease care.