If You Are Taking More Than 1 Medication

Posted on by Kaoru Kashima in Newsletter

For many people living in developed countries, taking medication for high blood pressure or high cholesterol has become a routine part of daily life. It’s almost like taking a morning vitamin—many people likely consider it “just the norm.” Also, it’s said that many people are taking not only high blood pressure medication but also other medications in combination.

The U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) define taking five or more medications per day as “polypharmacy.” Polypharmacy has grown increasingly common for nearly half of Americans aged 65 and older. According to data from the CDC and reports from the Lown Institute, the impact of polypharmacy in the US is substantial. In the US, Adverse Drug Events (ADEs) are a leading cause of preventable hospitalization and death. ADEs account for nearly 1.3 million emergency. It is estimated that medication overload and ADEs contribute to over 100,000 deaths per year in the US, making it a top-ten leading cause of death

If you have multiple health conditions, you may need to take several medications. However, the fact that “taking more medications carries its own risks” is often overlooked. What if the very medication you’re taking with the best of intentions is actually triggering a “medication chain reaction”—leading to new health issues and causing the number of medications you take to increase to two, three, or more?

The Trap of the “Prescription Cascade”

Behind the increase in medication lies a chain of events known as the “prescription cascade.” Both patients and doctors tend to assume that side effects appear “within a few days to a few weeks.” In reality, however, it is not uncommon for side effects to appear several months later. By that point, the connection to the initial medication has become unclear, so the doctor interprets the current symptoms as a “new illness” and prescribes yet another medication.  

For example, amlodipine, which is used to treat high blood pressure, can cause swelling in the legs.   In such cases, while medication adjustments should generally be considered, diuretics may sometimes be added to reduce swelling.  At first glance, it may seem like an improvement, but diuretics cause frequent urination, which increases the risk of falls at night, especially among the elderly. In some cases, stomach medication is prescribed along with pain relievers (such as Loxonin), and the stomach medication alone is continued for an extended period afterward. Some stomach medications (PPIs) have been linked to a risk of low magnesium levels and osteoporosis with long-term use.

Risks of Over-the-Counter Medications

When a doctor asks, “Are you currently taking any medications?”, many people tend to think, “Over-the-counter drugs aren’t real medicine” or “I don’t need to mention that.” However, certain combinations can pose serious risks.

Examples of combinations that require caution：

Over the counter medicinePrescriptionPotential risks
Cold medicine (containing ibuprofen and aspirin)Warfarin (blood-thinning medication)Risk of Cerebral Hemorrhage and Gastrointestinal Bleeding Skyrockets
Over-the-counter sleep aids (antihistamines)Sleeping pills and anti-anxiety medicationsExcessive drowsiness, falls, and respiratory depression
Over-the-counter cough medicine (containing dextromethorphan)Antidepressants (SSRIs)Serotonin syndrome (fever, confusion, muscle rigidity)

 The idea that “over-the-counter medications are safe” is a misconception. When taken in combination with prescription medications, they can cause unexpected side effects.

“Hidden Risks” Facing the Working-Age Population

Taking multiple medications is not just a problem for the elderly. People in their prime working years (in their 30s to 50s) face unique risks. A common trait of this generation is that they tend to put off seeing a doctor due to their busy schedules and often dismiss their symptoms as simply “fatigue” or “stress.”

A common pattern in their 30s to 50s:

Antidepressant (SSRI-Lexapro/Zoloft/Prozac) + Blood pressure medication (Lisinopril) + Sleeping pill (Ambien)

The combination of SSRIs and Ambien can easily lead to excessive sedation and dizziness the following day, increasing the risk of falls. Furthermore, a “prescription cascade”—where Ambien is used to treat insomnia caused by SSRIs—typically occurs. 23% of women in their 40s and 50s are taking antidepressants, which is the highest percentage across all age groups and genders.

A common pattern in men in their 40s and 50s:

Statins (Lipitor) + beta-blockers (Metoprolol) + diabetes medicine (Metformin)

Particular caution is required when combining beta-blockers with diabetes medications. Normally, when blood sugar drops too low, the body sends warning signals such as “palpitations” or “shaking hands.” However, beta-blockers block these warning signals, which can lead to dangerous hypoglycemia without the patient realizing it, potentially causing sudden loss of consciousness.

A common pattern in women in their 30s and 40s:

Thyroid hormone medication (Synthroid) + antidepressant (SSRI-Zoloft) + Pain reliever (Advil) Thyroid hormone medications must be taken at very specific times and interact with many other drugs. When taken in combination with SSRIs, they may also affect the serotonin system.

Primary Care Doctor Knows Everything Myth

Finally, I’d like to share a real-life example from my own experience.

My mother-in-law, who will turn 82 next month, has been experiencing noticeable forgetfulness and memory lapses ever since my father-in-law passed away nine years ago. She has been taking an antidepressant (Prozac) since her 30s, and she is now also taking medication for her thyroid.

She fell four times in the past month, so she finally went to the emergency room last week. The tests didn’t reveal any major abnormalities, but what caught the attending physician’s attention was her Prozac dosage. Her primary care physician had prescribed 80 mg—the maximum dose approved by the FDA. Furthermore, my mother-in-law had been taking over-the-counter sleeping pills on her own initiative. This combination is well known in the medical field as a major cause of “acute confusion” and delirium in the elderly.

“It’s okay because my long-time doctor prescribed it”—I understand why you’d want to think that. However, even your primary care physician may not have a complete understanding of all possible drug interactions. My mother-in-law’s experience made me strongly feel that patients, too, need to take an active interest in learning about their medications.

While medication can be necessary, allowing the number of medications you take to keep increasing carries risks. To avoid this, it’s important to follow these basic steps: (1) Make a list of all the medications you’re taking (including over-the-counter drugs and supplements); (2) Share this list with your doctor or pharmacist; and (3) Don’t ignore any unusual symptoms or side effects.

When used correctly, medications can save lives. However, if you keep taking medications “just because” or “because someone told you to,” the risks can increase without you even realizing it. When new symptoms appear, ask yourself this first:　 “Could this be caused by the medication I’m currently taking?” Since there are tools available in the U.S., such as the Drugs.com Interaction Checker, that allow you to check for drug interactions, it’s important to take a proactive approach rather than a passive one.

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Published by Kaoru Kashima

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