This document summarizes a study on polypharmacy among patients in South India. The study defined polypharmacy as using 2-4 drugs as minor polypharmacy and 5 or more drugs as major polypharmacy. It found that 59.82% of patients had major polypharmacy, occurring most in cardiovascular diseases. Polypharmacy was more prevalent in males and in ages 19-60 years. Hospital stays were longer for major polypharmacy. The study suggests simplifying treatment regimens by eliminating unnecessary drugs and dosages to reduce problems from polypharmacy.

1. JOURNAL CLUB

2. The Prevalence Of Polypharmacy In
South Indian Patients:
A Pharmacoepidemiological Approach
Mohammed S.S* et.al
By,
Dr.N.Pratyusha
10B0501

3. Introduction
Polypharmacy:
Defined as a condition in which a patient
receives too many drugs for too long time,
or drug in exceedingly high doses often
result in polypharmacy.

4. Potential risks of polypharmacy:
 Drug- Drug interactions
 Drug- Food interactions
 Adverse drug reactions
 Increased hospitalisation
 Medication errors
Eventually leading to increased pateint costs
and non-compliance to treatment.

5. Purpose of the study:
To develop a prescription database and to
compare different methods of identifying
drug users exposed to polypharmacy.

6. Methodology:
Study site: Govt Dist HQ hospital, Ooty
Study period : 9 months
Type of study: prospectively and retrospectively
Inclusion criteria: prescriptions containing more
than 1 drug and of age 2-70 yrs
Exclusion criteria: age less than 2 yrs,
psychiatric and cancer disorders

7. Classification:
According to BNF:
Minor Polypharmacy :
Concurrent use of 2 to 4 drugs
Major Polypharmacy :
Use of 5 or more drugs

8. Results:
Total number of prescriptions- 1003
Major polypharmacy- 600
Minor polypharmacy- 403
Total number of males- 670
Total number of females- 330

9. Fig1: Age vs total number of
prescriptions

10. Quantitative estimation of
polypharmacy:
1.Polypharmacy Vs Gender
Number of
drugs
Male Female Total Percentage
2-4 227 176 403 40.18%
Greater than
or equalto 5
443 157 600 59.82%

11. 2.Polypharmacy Vs Age
Both minor and major polypharmacy is
seen high in the age group of 19-60 yrs
that is 78.41% and 87.33% respectively.
3.Polypharmacy Vs Hospital stays
Hospital stay was found to be more for
major polypharmacy that is 45.50% (one
to two weeks of stay)

12. Quantitative estimation of therapeutic
categories of prescriptions:

13. 1.Therapeutic class Vs polypharmacy
Major polypharmacy is more prevalent in cardiovascular
diseases followed by infectious diseases.
2.Therapeutic class Vs Age group
Elderly- GI and cardiovascular drugs
Young- Infectious and CV drugs
3. Therapeutic class Vs Hospital stay
Short term therapy- GI and infectious diseases
Long term therapy- CV and respiratory diseases

14. Discussion
 Polypharmacy was a frequent condition in indian
population especially among elderly individuals.
 Patient case sheets were used for the estimation of
prevalence and incidence.
 More prevalent in the age group of 19-60 yrs.
 Higher prevalence of polypharmacy was seen in
men than women.

15. Discussion cntd..
 Length of hospital stay is found to be more in
major polypharmacy compared to minor.
 Prevalence of cardiovascular drugs and GI drugs
were more often involved in polypharmacy
among the elderly and infectious, cardiovascular
drugs were prominent among young individuals
exposed to polypharmacy.

16. Suggestions to reduce the problems
associated with polypharmacy, based on the
study:
 Ask patients to bring all medicines to the counseling
center (the brown bag approach)
 Restrict pro re nata prescribing
 Encourage physicians to prescribe using evidence-based
medicine
 Select a drug that may treat more than one condition
 Check for contraindications and potential drug
interactions before prescribing a drug

17.  Start with low doses and titrate dose according to effect
 Monitor for adverse reactions and check potential drug
interactions
 Educate the patient about the drug therapy and teach the
patient to prioritize the currently used drugs
 Routinely check and encourage compliance
 Periodically simplify the therapeutic regimen and stop
drugs if possible
 Place limits on the duration of drug prescribing

18. Conclusion:
The use of medication to disease condition is necessary, but unnecessary
load of drugs to patient will increase the safety problems.
Polypharmacy can be avoided by sharing the decisions for making
treatment goals and plans.
The medication regimen can be simplified by eliminating
pharmacological duplication, decreasing dosing frequency and regular
review of drug regimen.
The goal should be to prescribe the least complex drug regimen for the
patient as possible while considering the medication problems,
symptoms and ofcourse the cost of therapy.

19. Thank you