How Many Meds Per Day Is Too Many To Be Healthy?

We’ve talked before about the potential dangers of taking medications one does not need:

Are You Taking PIMs? Getting Off The Overmedication Train ← “PIMs” = “Potentially Inappropriate Medications”

Often, this does not come from misdiagnosis or hypochondria or just some odd desire to take medications, but rather, it happens when one medication (statins are a great example of this) causes a bunch of side effects, and these can then lead to a “side effect train” whereby the patient then has to take something else to treat the side effect, then something else to treat the side effect(s) of that medication, and so on, until they are taking an increasingly large stack of medications.

You can read on that in detail, here: Statins: His & Hers? ← because adverse side effects are much more common for women (and the benefits typically fewer/smaller for women) than for men.

But what about taking correctly-prescribed medications that all have a good reason and aren’t a case of treating a “side effect train”?

The rise of polypharmacy

“Polypharmacy” is defined as taking 5 or more medications concurrently.

Researchers (Dr. Caroline Sloan et al.) used data from a decades-long study to see how taking multiple medications affects strength, balance, and mobility in midlife.

Of 1,842 participants, approximately half being women and with an average age of 60 at the time of this research (the main study began 40 years ago), 29% were taking more than 5 medications concurrently, and 25% were taking at least one PIM.

Why this matters: those on 5 or more prescriptions:

• walked more slowly
• had weaker grip strength
• had worse balance
• scored lower on the CARDIA Physical Performance (CAPP) scale

…compared to those taking 4 or fewer medications concurrently.

Notably, it wasn’t the specific drugs (or their “appropriateness”) that mattered most, but the number of medications taken. PIM use was initially associated with a slightly lower lower CAPP score, but this association disappeared once adjusted for polypharmacy.

Caveat: the study doesn’t prove causation—underlying health conditions may be the shared reason for both polypharmacy and physical decline (i.e. someone who has poor health will take more medications, and it’s not the medications causing the ill health), but it shows a strong association in people as young as their 50s.

How this is useful: what this means is that polypharmacy could be an early red flag for mobility and strength decline, especially in cases where the medications are for something that medical science doesn’t yet understand well such as fibromyalgia, which is more a description than a useful diagnosis (see: Why Fibromyalgia Is Not An Acceptable Diagnosis).

In other words, polypharmacy should be regarded as an alarm bell for “maybe we need to look more into what’s going on here”, and even in cases where what’s going on is, in fact, well-understood, it can still serve as a “so we must be extra careful to maintain strength, speed, balance, etc”.

You can find the paper itself, here: Association Between Polypharmacy and Physical Function in Middle-aged Adults: Findings from the CARDIA Function Study

Want to learn more?

You may like this very good book that we reviewed a little while back:

To Medicate or Not? That is the Question!: How to Improve Your Blood Test Results with the Least Amount of Medication Possible – by Dr. Asha Bohannon

Take care!