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Feature Pharmaceuticals

Polypharmacy: a necessary evil

BMJ 2013; 347 doi: (Published 28 November 2013) Cite this as: BMJ 2013;347:f7033
  1. Jacqui Wise, freelance journalist
  1. 1London, UK
  1. jacquiyoung1{at}

The rise of patients taking four or more drugs is an aspect of modern medicine that requires some urgent attention, finds a new report. Jacqui Wise examines its recommendations

Polypharmacy is a term that first appeared in the medical literature more than 150 years ago, but according to a major report from the King’s Fund there is now an urgent need to tackle the issue.1

In the past 10 years the average number of items prescribed for each person per year in England has increased by 53.8%, from 11.9 in 2001 to 18.3 in 2011.2 A Scottish study of more than 300 000 patients found that between 1995 and 2010 the proportion of patients receiving five or more drugs increased from 12% to 22% and the proportion receiving 10 or more drugs rose from 1.9% to 5.8% (figure).3 For older people the figures are even higher, with one in six patients over the age of 65 receiving 10 or more drugs.3

Proportion of patients in Scotland receiving more than one drug, 1995 and 20101 3

The rise in polypharmacy is driven by the growth of an ageing and increasingly frail population, many of whom have multiple long term conditions. In addition, increasing numbers of patients are prescribed complicated prevention regimens to reduce their future risk of serious events such as stroke and acute myocardial infarction.

“Polypharmacy is a necessary evil,” said Martin Duerden, a general practitioner and coauthor of the King’s Fund report Polypharmacy and Medicines Optimisation: Making It Safe and Sound. “It used to always be frowned on, but now we accept that it has to be a part of modern medicine. But we need to endeavour to ensure that we use multiple treatments in the most effective and least harmful way.” …

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