[Pitfalls of polypharmacy, particularly in the elderly]

Many patients, especially those aged over 70 years, receive variable types of polypharmacy in western countries. Polytherapy may be naturally in accordance with good clinical practice, or vice versa, it may be unjustified, whether it results from inappropriate prescribing or self-medication. Major causes of polytherapy include the presence of multiple disease states, thereby necessitating multiple drug therapy, particularly in patients with chronic debilitating disorders; increasing demand for health care; therapeutic advances as well as excessive prescribing (which may be related to poor coordination between practitioners). Polypharmacy may result in: increased rates of adverse drug reactions, as a frequent consequence of drug-drug interactions; errors in medication-taking, including poor compliance due to drug-associated untoward effects and medication errors; both direct and indirect additional costs for the health insurance scheme. Preventive measures of adverse drug reactions should include: appropriate clinical trials to improve knowledge of risks of polytherapy in elderly patients and other patients at high risk for developing drug-related side-effects; improved adverse drug reaction reporting to the pharmaco-vigilance systems provision of information about drug side-effects to all health care professionals as well as to patients.