A/Prof Sarah Hilmer
Main occupation: Clinical pharmacologist
Years in clinical practice at interview: 16
Qualifications: BScMed (Hons), MBBS (Hons), FRACP, PhD
We asked Associate Professor Sarah Hilmer, clinical pharmacologist and geriatrician, for her perspective on our definition of multiple medicines being ‘five or more medicines’. Her view is that polypharmacy is a ‘red flag’ that signals a greater risk of having problems with medicines. She describes what people who take a number of medicines need to be aware of.
Look, the definition of polypharmacy is hotly contested. And some people use a cut-off number and others say that polypharmacy is just being on anything that is unnecessary.
My opinion is that polypharmacy is really a red flag. It's not really the number of medicines you're on that is inherently a problem, but the more medicines you are on, the higher risk you are of having medication-loaded problems. So you could be on five medications and be fine, but if you are on five medications, you are at a much higher risk of being on an unnecessary medicine or a medicine that will cause you adverse reactions, or a medicine that will interact with one of your other medicines, than if you are only on one or two. So I see polypharmacy really as a red flag that you are at high risk.
I think it is important that patient's understand that, while sometimes you need a lot of medicines, it is risky. And the other thing for patients to really understand in that context, is that because it's risky, they shouldn't really try to make changes by themselves. And that includes starting and stopping things.
If you are already on quite a few medicines, if you have medical problems, then before you start anything, even something over the counter or a vitamin or a herb, check with your doctor, and again before you stop something talk to your doctor about whether you can stop it or whether you need to withdraw it and how that will impact on your other medicines.